DA Form 4465 Patient Intake / Screening Record (Pir)

DA Form 4465 Patient Intake / Screening Record (Pir)

What Is DA Form 4465?

This is a military form that was released by the U.S. Department of the Army (DA) on November 1, 2001. The form, often mistakenly referred to as the DD Form 4465, 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 the DA Form 4465?
A: The DA Form 4465 is the Patient Intake/Screening Record (PIR) used by the military.

Q: What is the purpose of DA Form 4465?
A: The purpose of DA Form 4465 is to gather necessary information about patients during intake and screening.

Q: Who uses the DA Form 4465?
A: The DA Form 4465 is used by the military personnel responsible for the intake and screening of patients.

Q: What information is collected on the DA Form 4465?
A: The DA Form 4465 collects information such as personal details, medical history, and reason for seeking medical attention.

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Form Details:

  • A 2-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 fillable DA Form 4465 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

Download DA Form 4465 Patient Intake / Screening Record (Pir)

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