DA Form 7595-5-1 Initiate a Field Medical Card

DA Form 7595-5-1 or the "Initiate A Field Medical Card" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 7595-5-1 - was last revised on March 1, 2014. Download an up-to-date fillable DA Form 7595-5-1 down below in PDF-format or look it up on the Army Publishing Directorate website.

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INITIATE A FIELD MEDICAL CARD
For use of this form see TC 8-800; the proponent agency is TRADOC.
V
TABLE:
STP 8-68W13-SM-TG, Task: 081-831-0033, Initiate a Field Medical Card.
REFERENCE:
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
AUTHORITY:
S
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 the
ROUTINE USES:
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 (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
While responding to an emergency call, you encounter SPC Joe J. Hartz, 888-45-6789, an alert 24 year old male relating a chief complaint of external
bleeding from a gunshot wound to the right thigh. He says that he is in the Infantry, MOS 11B, with no religious preference, and was in a firefight. When
the firefight was over he noticed his leg was bleeding. His airway is open; his respirations are 16 and strong. He has a radial pulse of 90, and his blood
pressure is 120 over 80. You have applied a field dressing to the wound to control the bleeding; no medication was given. Using
DD Form 1380 (US Field Medical Card), record the appropriate information.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Removed protective sheet from the carbon copy of the DD Form 1380.
b. Completed Block 1.
c. Completed Block 3.
d. Completed Block 4.
e. Completed Block 7.
f. Completed Block 9.
g. Completed Block 11.
h. Attached DD Form 1380 to the patient's uniform.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial Evaluator
8. Start Time
9. Stop 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.
Supersedes DA Form 7595-20-R, MAY 2009
DA FORM 7595-5-1, MAR 2014
APD LC v1.00
INITIATE A FIELD MEDICAL CARD
For use of this form see TC 8-800; the proponent agency is TRADOC.
V
TABLE:
STP 8-68W13-SM-TG, Task: 081-831-0033, Initiate a Field Medical Card.
REFERENCE:
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
AUTHORITY:
S
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 the
ROUTINE USES:
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 (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
While responding to an emergency call, you encounter SPC Joe J. Hartz, 888-45-6789, an alert 24 year old male relating a chief complaint of external
bleeding from a gunshot wound to the right thigh. He says that he is in the Infantry, MOS 11B, with no religious preference, and was in a firefight. When
the firefight was over he noticed his leg was bleeding. His airway is open; his respirations are 16 and strong. He has a radial pulse of 90, and his blood
pressure is 120 over 80. You have applied a field dressing to the wound to control the bleeding; no medication was given. Using
DD Form 1380 (US Field Medical Card), record the appropriate information.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Removed protective sheet from the carbon copy of the DD Form 1380.
b. Completed Block 1.
c. Completed Block 3.
d. Completed Block 4.
e. Completed Block 7.
f. Completed Block 9.
g. Completed Block 11.
h. Attached DD Form 1380 to the patient's uniform.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial Evaluator
8. Start Time
9. Stop 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.
Supersedes DA Form 7595-20-R, MAY 2009
DA FORM 7595-5-1, MAR 2014
APD LC v1.00

Download DA Form 7595-5-1 Initiate a Field Medical Card

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