DA Form 5008 Telephone Medical Advice/Consultation Record

DA Form 5008 - also known as the "Telephone Medical Advice/consultation Record" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 5008 - was last revised on October 1, 1981. Download an up-to-date fillable PDF version of the DA 5008 below or request a copy through the chain of command.

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NAME (Last, First, MI)
TELEPHONE NO.
TELEPHONE MEDICAL ADVICE/CONSULTATION RECORD
For use of form, see AR 40-66; the proponent agency is the OTSG.
ORGANIZATION OF PATIENT/SPONSOR
FMP
SSN OF PATIENT/SPON-
LOCATION OF PATIENTS MEDICAL
RECORD
SOR
CENTRAL FILES AREA
OTHER (Specify)
HOSPITAL AND CLINIC IDENTIFICATION
SERVICE AFFILIATION
ARMY
NAVY
MARINE CORPS
AIR FORCE
OTHER (Specify)
BENEFICIARY CATEGORY
AD
DEPN AD
RET
DEPN RET
DEPN RET/DECD
OTHER (Specify)
PATIENT STATUS
DATE AND TIME OF CALL
INPATIENT
OUTPATIENT
EMERGENCY
NON-EMERGENCY
SUMMARY (Include complaint, diagnosis, instructions to patient)
SIGNATURE OF PHYSICIAN/CARE PROVIDER
CHECK IF CONTINUED ON REVERSE
DA FORM 5008, OCT 1981
PAGE 1 of 2
APD LC v1.02ES
NAME (Last, First, MI)
TELEPHONE NO.
TELEPHONE MEDICAL ADVICE/CONSULTATION RECORD
For use of form, see AR 40-66; the proponent agency is the OTSG.
ORGANIZATION OF PATIENT/SPONSOR
FMP
SSN OF PATIENT/SPON-
LOCATION OF PATIENTS MEDICAL
RECORD
SOR
CENTRAL FILES AREA
OTHER (Specify)
HOSPITAL AND CLINIC IDENTIFICATION
SERVICE AFFILIATION
ARMY
NAVY
MARINE CORPS
AIR FORCE
OTHER (Specify)
BENEFICIARY CATEGORY
AD
DEPN AD
RET
DEPN RET
DEPN RET/DECD
OTHER (Specify)
PATIENT STATUS
DATE AND TIME OF CALL
INPATIENT
OUTPATIENT
EMERGENCY
NON-EMERGENCY
SUMMARY (Include complaint, diagnosis, instructions to patient)
SIGNATURE OF PHYSICIAN/CARE PROVIDER
CHECK IF CONTINUED ON REVERSE
DA FORM 5008, OCT 1981
PAGE 1 of 2
APD LC v1.02ES
(Continuation of summary and/or follow-up note)
SIGNATURE OF PHYSICIAN/CARE PROVIDER
INSTRUCTIONS FOR COMPLETION AND PROCESSING OF FORM
1. The upper portion of the form, pertaining to patient information, will generally be completed by the individual
responsible for screening incoming calls.
2. The entire set will be provided the physician/care provider for documenting the conversation.
3. The duplicate of the form will be retained for processing in accordance with local policy for medical summary
reporting purposes.
4. For outpatient calls, the original form will be forwarded to the custodian of the patient's outpatient treatment
record/HREC for attaching to a SF 600 therein.
5. For inpatient calls, the original form is forwarded to the custodian of the patient's inpatient treatment record.
PAGE 2 of 2
DA FORM 5008, OCT 1981
APD LC v1.02ES

Download DA Form 5008 Telephone Medical Advice/Consultation Record

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