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DA Form 4254 Request for Private Medical Information
What Is DA Form 4254?
This is a military form that was released by the U.S. Department of the Army (DA) on February 1, 2003. The form, often mistakenly referred to as the DD Form 4254, 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 4254?
A: DA Form 4254 is a Request for Private Medical Information form.
Q: What is the purpose of DA Form 4254?
A: The purpose of DA Form 4254 is to request private medical information.
Q: Who uses DA Form 4254?
A: DA Form 4254 is used by the military and government organizations.
Q: What information is requested on DA Form 4254?
A: DA Form 4254 requests private medical information, including the patient's name, social security number, and medical condition.
Q: Is DA Form 4254 mandatory?
A: In certain situations, the completion of DA Form 4254 may be mandatory.
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 4254 down below in PDF format or browse hundreds of other DA Forms stored in our online database.
