DA Form 4159 Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense

DA Form 4159 Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense

What Is DA Form 4159?

This is a military form that was released by the U.S. Department of the Army (DA) on May 1, 2009. The form, often mistakenly referred to as the DD Form 4159, 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.

FAQ

Q: What is DA Form 4159?
A: DA Form 4159 is the Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense.

Q: What is the purpose of DA Form 4159?
A: The purpose of DA Form 4159 is to request medical care in a federal medical treatment facility outside the Department of Defense.

Q: Who uses DA Form 4159?
A: DA Form 4159 is used by military personnel and their dependents to request medical care.

Q: Is DA Form 4159 mandatory?
A: Yes, DA Form 4159 is mandatory for military personnel and their dependents seeking medical care outside the Department of Defense.

Q: Can civilians use DA Form 4159?
A: No, DA Form 4159 is specifically for military personnel and their dependents.

Q: Are there any fees associated with using DA Form 4159?
A: There may be fees associated with medical care provided in a federal medical treatment facility outside the Department of Defense, but these fees are not related to the form itself.

Q: What information is required on DA Form 4159?
A: DA Form 4159 requires information such as the patient's personal information, the nature of the medical condition, and the desired treatment facility.

Q: How long does it take to process a request on DA Form 4159?
A: The processing time may vary, but it is recommended to submit the form well in advance to allow for sufficient processing time.

Q: Can I submit a request for non-emergency medical care on DA Form 4159?
A: Yes, DA Form 4159 can be used to request non-emergency medical care in a federal medical treatment facility outside the Department of Defense.

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Form Details:

  • A 1-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
  • Editable, free, and easy to use;
  • Fill out the form in our online filing application.

Download an up-to-date fillable DA Form 4159 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

Download DA Form 4159 Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense

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  • DA Form 4159 Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense, Page 1
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