DA Form 3888-3 "Medical Record - Nursing Discharge Summary"

What Is DA Form 3888-3?

This is a military form that was released by the U.S. Department of the Army (DA) on June 1, 1991. The form, often mistakenly referred to as the DD Form 3888-3, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 3-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
  • Editable, free, and easy to use;

Download an up-to-date printable DA Form 3888-3 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 3888-3 "Medical Record - Nursing Discharge Summary"

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MEDICAL RECORD - NURSING DISCHARGE SUMMARY
For use of this form, see AR 40-66; the proponent agency is OTSG
Other (specify)
1.
Date/Time:
2.
Discharge to:
Home
4.
Accompanied by:
Other (specify)
3.
Mode:
Ambulatory
Limitations (specify)
5.
Activity:
Patient and/or Significant Other (S.O.) communicates knowledge and understanding of activity limitations.
6.
Diet:
No Dietary Restrictions
If special, identify
Patient/S.O. communicates understanding of dietary restrictions.
7.
Medications:
No Medication Required
Name of Medication
Dosage
Frequency of Medication
Special Instructions
Patient and/or S.O. communicates knowledge and understanding of name, dosage, frequency and special instructions.
8.
Treatments/Care:
Patient/S.O. observed
Patient/S.O. Returned
Instructions Given:
Demonstrations (Date)
Demonstration (Date)
Equipment/Supplies (Specify)
9.
Follow-up: You should be seen in
clinic in
(time period).
Patient/S.O. communicates understanding of follow-up instructions.
10.
Patient's Condition (Health Status relative to Nursing Care Plan):
11.
Signature (Registered Nurse)
12.
Additional Information:
13.
Patient Identification:
COPY 1 - INPATIENT RECORD COPY
DA FORM 3888-3, JUN 91
REPLACES DA FORM 3888-5 (TEST), AUG 85 WHICH IS OBSOLETE.
USAPPC V1.00
MEDICAL RECORD - NURSING DISCHARGE SUMMARY
For use of this form, see AR 40-66; the proponent agency is OTSG
Other (specify)
1.
Date/Time:
2.
Discharge to:
Home
4.
Accompanied by:
Other (specify)
3.
Mode:
Ambulatory
Limitations (specify)
5.
Activity:
Patient and/or Significant Other (S.O.) communicates knowledge and understanding of activity limitations.
6.
Diet:
No Dietary Restrictions
If special, identify
Patient/S.O. communicates understanding of dietary restrictions.
7.
Medications:
No Medication Required
Name of Medication
Dosage
Frequency of Medication
Special Instructions
Patient and/or S.O. communicates knowledge and understanding of name, dosage, frequency and special instructions.
8.
Treatments/Care:
Patient/S.O. observed
Patient/S.O. Returned
Instructions Given:
Demonstrations (Date)
Demonstration (Date)
Equipment/Supplies (Specify)
9.
Follow-up: You should be seen in
clinic in
(time period).
Patient/S.O. communicates understanding of follow-up instructions.
10.
Patient's Condition (Health Status relative to Nursing Care Plan):
11.
Signature (Registered Nurse)
12.
Additional Information:
13.
Patient Identification:
COPY 1 - INPATIENT RECORD COPY
DA FORM 3888-3, JUN 91
REPLACES DA FORM 3888-5 (TEST), AUG 85 WHICH IS OBSOLETE.
USAPPC V1.00
MEDICAL RECORD - NURSING DISCHARGE SUMMARY
For use of this form, see AR 40-66; the proponent agency is OTSG
Other (specify)
1.
Date/Time:
2.
Discharge to:
Home
4.
Accompanied by:
Other (specify)
3.
Mode:
Ambulatory
Limitations (specify)
5.
Activity:
Patient and/or Significant Other (S.O.) communicates knowledge and understanding of activity limitations.
6.
Diet:
No Dietary Restrictions
If special, identify
Patient/S.O. communicates understanding of dietary restrictions.
7.
Medications:
No Medication Required
Name of Medication
Dosage
Frequency of Medication
Special Instructions
Patient and/or S.O. communicates knowledge and understanding of name, dosage, frequency and special instructions.
8.
Treatments/Care:
Patient/S.O. observed
Patient/S.O. Returned
Instructions Given:
Demonstrations (Date)
Demonstration (Date)
Equipment/Supplies (Specify)
9.
Follow-up: You should be seen in
clinic in
(time period).
Patient/S.O. communicates understanding of follow-up instructions.
10.
Patient's Condition (Health Status relative to Nursing Care Plan):
11.
Signature (Registered Nurse)
12.
Additional Information:
13.
Patient Identification:
COPY 2 - PATIENT COPY
DA FORM 3888-3, JUN 91
REPLACES DA FORM 3888-5 (TEST), AUG 85 WHICH IS OBSOLETE.
USAPPC V1.00
MEDICAL RECORD - NURSING DISCHARGE SUMMARY
For use of this form, see AR 40-66; the proponent agency is OTSG
Other (specify)
1.
Date/Time:
2.
Discharge to:
Home
4.
Accompanied by:
Other (specify)
3.
Mode:
Ambulatory
Limitations (specify)
5.
Activity:
Patient and/or Significant Other (S.O.) communicates knowledge and understanding of activity limitations.
6.
Diet:
No Dietary Restrictions
If special, identify
Patient/S.O. communicates understanding of dietary restrictions.
7.
Medications:
No Medication Required
Name of Medication
Dosage
Frequency of Medication
Special Instructions
Patient and/or S.O. communicates knowledge and understanding of name, dosage, frequency and special instructions.
8.
Treatments/Care:
Patient/S.O. observed
Patient/S.O. Returned
Instructions Given:
Demonstrations (Date)
Demonstration (Date)
Equipment/Supplies (Specify)
9.
Follow-up: You should be seen in
clinic in
(time period).
Patient/S.O. communicates understanding of follow-up instructions.
10.
Patient's Condition (Health Status relative to Nursing Care Plan):
11.
Signature (Registered Nurse)
12.
Additional Information:
13.
Patient Identification:
COPY 3 - HEALTH RECORD / OUTPATIENT TREATMENT
RECORD COPY
DA FORM 3888-3, JUN 91
REPLACES DA FORM 3888-5 (TEST), AUG 85 WHICH IS OBSOLETE.
USAPPC V1.00
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