DA Form 4160 Patient's Personal Effects and Clothing Record

DA Form 4160 - also known as the "Patient's Personal Effects And Clothing Record" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 4160 - was last revised on October 1, 1973. Download an up-to-date fillable PDF version of the DA 4160 down below or look it up on the Army Publishing Directorate website.

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PATIENT'S PERSONAL EFFECTS AND CLOTHING RECORD
For use of this form, see AR 40-400; the proponent agency is the Office of The Surgeon General.
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last,
HOSPITAL ITEMS RECEIVED BY PATIENT
first, middle initial; grade; social security number, register number medical
facility or organization)
COAT, PAJAMA
TOWELS, BATH
TROUSERS, PAJAMA
WASH CLOTH
CONVALESCENT SUIT
OTHER
ROBE, BATH
SLIPPERS
PATIENT'S INITIALS
TOWELS, HAND
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
DATE
INITIALS OF CUSTODIAN
INITIALS OF PATIENT
ITEMS (Male and Female)
QUANTITY - PATIENT'S PERSONAL EFFECTS AND CLOTHING
ANKLETS, WOMEN'S
BAGS, DUFFEL/BARRACKS
BATHROBE
BELT
BUCKLE
BLOUSE, SUMMER/WINTER
BOOTS, COMBAT
CAP, GARRISON
CAP, NURSES, WHITE
CAP, SERVICE
CAP, UTILITY
COAT, WOOL
DRAWERS, SUMMER/WINTER
DRESS, COTTON
GLOVES, PR. COTTON/LEATHER
GLOVES, INSERT
GLOVES, SHELL
HANDBAG, LEATHER
HANDKERCHIEFS
HAT, SERVICE
INSIGNIA, CAP/HAT
INSIGNIA, COLLAR, SHOULDER
JACKET, UTILITY
JACKET, FIELD
JACKET, WOOL
NECKTIE
NIGHTGOWNS
OVERCOAT
OVERSHOES/RUBBERS
PAJAMAS
PONCHO
PANTIES, WOMEN
RAINCOAT
SCARF
SHIRT
SHIRTWAIST, WOMEN
DA FORM 4160, 1 OCT 1973
APD LC v1.00
REPLACES DA FORM 8-111, 1 OCT 1957 WHICH IS OBSOLETE
PATIENT'S PERSONAL EFFECTS AND CLOTHING RECORD
For use of this form, see AR 40-400; the proponent agency is the Office of The Surgeon General.
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last,
HOSPITAL ITEMS RECEIVED BY PATIENT
first, middle initial; grade; social security number, register number medical
facility or organization)
COAT, PAJAMA
TOWELS, BATH
TROUSERS, PAJAMA
WASH CLOTH
CONVALESCENT SUIT
OTHER
ROBE, BATH
SLIPPERS
PATIENT'S INITIALS
TOWELS, HAND
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
DATE
INITIALS OF CUSTODIAN
INITIALS OF PATIENT
ITEMS (Male and Female)
QUANTITY - PATIENT'S PERSONAL EFFECTS AND CLOTHING
ANKLETS, WOMEN'S
BAGS, DUFFEL/BARRACKS
BATHROBE
BELT
BUCKLE
BLOUSE, SUMMER/WINTER
BOOTS, COMBAT
CAP, GARRISON
CAP, NURSES, WHITE
CAP, SERVICE
CAP, UTILITY
COAT, WOOL
DRAWERS, SUMMER/WINTER
DRESS, COTTON
GLOVES, PR. COTTON/LEATHER
GLOVES, INSERT
GLOVES, SHELL
HANDBAG, LEATHER
HANDKERCHIEFS
HAT, SERVICE
INSIGNIA, CAP/HAT
INSIGNIA, COLLAR, SHOULDER
JACKET, UTILITY
JACKET, FIELD
JACKET, WOOL
NECKTIE
NIGHTGOWNS
OVERCOAT
OVERSHOES/RUBBERS
PAJAMAS
PONCHO
PANTIES, WOMEN
RAINCOAT
SCARF
SHIRT
SHIRTWAIST, WOMEN
DA FORM 4160, 1 OCT 1973
APD LC v1.00
REPLACES DA FORM 8-111, 1 OCT 1957 WHICH IS OBSOLETE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
ITEMS (Male and Female)
QUANTITY - PATIENT'S PERSONAL EFFECTS AND CLOTHING
SHIRT, WOOL
SHOES, DRESS/SPORT
SHOES, LOW-QTR
SHOES, SERVICE
SHORTS, UNIFORM, KHAKI
SKIRT
SLACKS
SLIP
SOCKS, PRS
STOCKINGS, PRS
SUIT, EXERCISE, WOMEN
SWEATER
TOWELS
TROUSERS, COTTON, KHAKI
TROUSERS, WOOL
UNDERSHIRTS, WINTER/SUMMER
UNIFORM, NURSES HOSPITAL
UNIFORM, WOMEN, WINTER SUMMER
CIVILIAN
BELT, COLOR
CAP/HAT
COAT, SPORT
SHIRT, DRESS/SPORT
SHOES, SPORT, DRESS, COLOR
SLACK, COLOR
SUIT, 2 PC, 3 PC
TOP COAT
OTHER
ALL ITEMS IN THE LAST COMPLETED COLUMN HAVE BEEN RECEIVED
SIGNATURE AND GRADE OF PATIENT
SIGNATURE AND GRADE OF CUSTODIAN
DATE
DATE
DA FORM 4160, 1 OCT 1973
APD LC v1.00

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