DD Form 7 Report of Treatment Furnished Pay Patients Hospitalization Furnished (Part a)

DD Form 7 or the "Report Of Treatment Furnished Pay Patients Hospitalization Furnished (part A)" is a Department of Defense-issued form used by and within the United States Army.

The form - often mistakenly referred to as the DA form 7 - was last revised on January 1, 1976. Download an up-to-date fillable PDF version of the DD 7 down below or find it on the Department of Defense documentation website.

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REPORT OF TREATMENT FURNISHED PAY PATIENTS
REPORT CONTROL SYMBOL
DD-HA(M)1990
HOSPITALIZATION FURNISHED (PART A)
1. INSTALLATION PROVIDING HOSPITALIZATION (Name and address)
2. MONTH AND YEAR COVERED BY THIS
REPORT
3. CATEGORY OF PATIENTS
4. AUTHORITY FOR ADMISSION
DATES
NAME (Last, first, middle initial)
MILITARY
AND SSN
GRADE
ORGANIZATION
DIAGNOSIS
ADMISSION
DISCHARGE
TOTAL
5
6
7
8
9
10
11
12. DATE
13. AUTHENTICATION (Signature, military grade, organization of Commanding Officer)
14. TOTAL DAYS HOSPITALIZED
0
DD Form 7, JAN 76
EDITION OF 1 APR 50 WILL BE USED UNTIL EXHAUSTED
Reset
Adobe Professional 7.0
REPORT OF TREATMENT FURNISHED PAY PATIENTS
REPORT CONTROL SYMBOL
DD-HA(M)1990
HOSPITALIZATION FURNISHED (PART A)
1. INSTALLATION PROVIDING HOSPITALIZATION (Name and address)
2. MONTH AND YEAR COVERED BY THIS
REPORT
3. CATEGORY OF PATIENTS
4. AUTHORITY FOR ADMISSION
DATES
NAME (Last, first, middle initial)
MILITARY
AND SSN
GRADE
ORGANIZATION
DIAGNOSIS
ADMISSION
DISCHARGE
TOTAL
5
6
7
8
9
10
11
12. DATE
13. AUTHENTICATION (Signature, military grade, organization of Commanding Officer)
14. TOTAL DAYS HOSPITALIZED
0
DD Form 7, JAN 76
EDITION OF 1 APR 50 WILL BE USED UNTIL EXHAUSTED
Reset
Adobe Professional 7.0

Download DD Form 7 Report of Treatment Furnished Pay Patients Hospitalization Furnished (Part a)

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