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DA Form 4465 Patient Intake / Screening Record (Pir)
What Is DA Form 4465?
This is a military form that was released by the U.S. Department of the Army (DA) on November 1, 2001. The form, often mistakenly referred to as the DD Form 4465, 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 the DA Form 4465?
A: The DA Form 4465 is the Patient Intake/Screening Record (PIR) used by the military.
Q: What is the purpose of DA Form 4465?
A: The purpose of DA Form 4465 is to gather necessary information about patients during intake and screening.
Q: Who uses the DA Form 4465?
A: The DA Form 4465 is used by the military personnel responsible for the intake and screening of patients.
Q: What information is collected on the DA Form 4465?
A: The DA Form 4465 collects information such as personal details, medical history, and reason for seeking medical attention.
Form Details:
- A 2-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 4465 down below in PDF format or browse hundreds of other DA Forms stored in our online database.
Download DA Form 4465 Patient Intake / Screening Record (Pir)
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