PDF
Word
DA Form 5009 Release Against Medical Advice
What Is DA Form 5009?
This is a military form that was released by the U.S. Department of the Army (DA) on February 1, 2004. The form, often mistakenly referred to as the DD Form 5009, 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 DA Form 5009?A: DA Form 5009 is a military form used to document a patient's decision to leave a medical facility against the advice of their healthcare provider.
Q: What does it mean to release against medical advice?A: Releasing against medical advice means that a patient chooses to leave a medical facility even though their healthcare provider advises against it due to potential risks or complications.
Q: Why would someone choose to release against medical advice?A: There are various reasons why someone may choose to release against medical advice, such as dissatisfaction with the care received, personal obligations, or a desire to seek alternative treatments.
Q: What information is documented on DA Form 5009?A: DA Form 5009 documents the patient's name, reason for release, signature, and the signatures of witnesses and healthcare providers.
Q: Can a patient be forced to stay in a medical facility against their will?A: In general, a patient cannot be forced to stay in a medical facility against their will unless there are specific legal circumstances, such as the patient being a danger to themselves or others.
Q: What are the potential consequences of releasing against medical advice?A: Releasing against medical advice may have potential consequences, including risks to the patient's health, limited insurance coverage, and the inability to hold the medical facility responsible for any adverse outcomes.
Q: Are there any alternatives to releasing against medical advice?A: If a patient is considering releasing against medical advice, it is recommended to discuss concerns and possible alternatives with their healthcare provider to determine the best course of action.
Q: Is DA Form 5009 specific to the military?A: Yes, DA Form 5009 is a military form used by the United States Army, but similar forms may be used in other branches of the military or even civilian medical facilities.
Form Details:
- A 1-page document available for download in PDF;
- The latest version available from the Army Publishing Directorate;
- Editable, free, and easy to use;
- Fill out the form in our online filing application.
Download an up-to-date fillable DA Form 5009 down below{class="scroll_to"} in PDF format or browse hundreds of other DA Forms stored in our online database.
