DD Form 7A Report of Treatment Furnished Pay Patients Outpatient Furnished (Part B)

DD Form 7A or the "Report Of Treatment Furnished Pay Patients Outpatient Furnished (part B)" 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 7A - was last revised on August 1, 1976. Download an up-to-date fillable PDF version of the DD 7A 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
OUTPATIENT TREATMENT FURNISHED (PART B)
1. INSTALLATION PROVIDING TREATMENT (Name and address)
2. MONTH AND YEAR COVERED BY THIS REPORT
3. CATEGORY OF PATIENTS
4. AUTHORITY FOR ADMISSION
TREATMENT
MILITARY
NAME (Last, first, middle initial) AND SSN
GRADE
ORGANIZATION
DIAGNOSIS
DATES
NUMBER
5
6
7
8
9
10
11. DATE
12. AUTHENTICATION (Signature, military grade, organization of Commanding Officer)
13. TOTAL
0
DD Form 7A, AUG 76
Reset
Adobe Professional 7.0
REPORT OF TREATMENT FURNISHED PAY PATIENTS
REPORT CONTROL SYMBOL
DD-HA(M)1990
OUTPATIENT TREATMENT FURNISHED (PART B)
1. INSTALLATION PROVIDING TREATMENT (Name and address)
2. MONTH AND YEAR COVERED BY THIS REPORT
3. CATEGORY OF PATIENTS
4. AUTHORITY FOR ADMISSION
TREATMENT
MILITARY
NAME (Last, first, middle initial) AND SSN
GRADE
ORGANIZATION
DIAGNOSIS
DATES
NUMBER
5
6
7
8
9
10
11. DATE
12. AUTHENTICATION (Signature, military grade, organization of Commanding Officer)
13. TOTAL
0
DD Form 7A, AUG 76
Reset
Adobe Professional 7.0

Download DD Form 7A Report of Treatment Furnished Pay Patients Outpatient Furnished (Part B)

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