DA Form 7595-1-17 Initiate Treatment for Foreign Bodies of the Eye

DA Form 7595-1-17 - also known as the "Initiate Treatment For Foreign Bodies Of The Eye" - 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 7595-1-17 - was last revised on April 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-1-17 below or request a copy through the chain of command.

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INITIATE TREATMENT FOR FOREIGN BODIES OF THE EYE
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0039, Initiate Treatment for Foreign Bodies of the Eye
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and
AUTHORITY:
S
Development.
PRINCIPAL PURPOSE:
To ensure that accomplishment of training is properly credited to the correct individual for NREMT
certification IAW AR 40-68, AR 220-1 and AR 350-1.
Used by Unit personnel to monitor training. The DOD "Blanket Routine uses" set forth at the beginning of
ROUTINE USES:
the Army's compilation of system of records notices may apply to this system.
DISCLOSURE:
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error
in processing applicable favorable personnel actions. For Official Use Only.
1. Soldier's (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
A patient presents to the battalion aid station for pain in his right eye. He claims his eye hit a bush during a patrol. You must initiate treatment for an
ocular foreign body.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Performed visual acuity testing.
b. Assessed the eyes: pupils equal and round, regular in size and react to light.
c. Located the foreign body.
d. Removed the foreign body, if superficial.
e. Repeated visual acuity examination if foreign body is removed.
f. Did not remove embedded or impaled foreign bodies.
g. Obtained details about the injury.
h. Recorded all treatment on the patient's DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
i. Evacuated the patient.
4. Demonstrated Proficiency
Yes
No
6. Stop Time
7. Initial Evaluator
5. Start Time
9. Stop Time
8. Start Time
10. Retest Evaluator
12. Stop Time
13. Final Evaluator
11. Start Time
14. Evaluator's Comments
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyrighted material from National
Registry of Emergency Medical Technicians, Inc. (NREMT), skill sheets ©2011, this form has neither been prepared nor approved by NREMT.
Use is restricted to guidelines contained in the Preface to TC 8-800.
DA FORM 7595-1-17, APR 2014
APD LC v1.00
INITIATE TREATMENT FOR FOREIGN BODIES OF THE EYE
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0039, Initiate Treatment for Foreign Bodies of the Eye
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and
AUTHORITY:
S
Development.
PRINCIPAL PURPOSE:
To ensure that accomplishment of training is properly credited to the correct individual for NREMT
certification IAW AR 40-68, AR 220-1 and AR 350-1.
Used by Unit personnel to monitor training. The DOD "Blanket Routine uses" set forth at the beginning of
ROUTINE USES:
the Army's compilation of system of records notices may apply to this system.
DISCLOSURE:
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error
in processing applicable favorable personnel actions. For Official Use Only.
1. Soldier's (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
A patient presents to the battalion aid station for pain in his right eye. He claims his eye hit a bush during a patrol. You must initiate treatment for an
ocular foreign body.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Performed visual acuity testing.
b. Assessed the eyes: pupils equal and round, regular in size and react to light.
c. Located the foreign body.
d. Removed the foreign body, if superficial.
e. Repeated visual acuity examination if foreign body is removed.
f. Did not remove embedded or impaled foreign bodies.
g. Obtained details about the injury.
h. Recorded all treatment on the patient's DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
i. Evacuated the patient.
4. Demonstrated Proficiency
Yes
No
6. Stop Time
7. Initial Evaluator
5. Start Time
9. Stop Time
8. Start Time
10. Retest Evaluator
12. Stop Time
13. Final Evaluator
11. Start Time
14. Evaluator's Comments
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyrighted material from National
Registry of Emergency Medical Technicians, Inc. (NREMT), skill sheets ©2011, this form has neither been prepared nor approved by NREMT.
Use is restricted to guidelines contained in the Preface to TC 8-800.
DA FORM 7595-1-17, APR 2014
APD LC v1.00

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