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DD Form 689 Individual Sick Slip
What Is DD Form 689?
DD Form 689, Individual Sick Slip, is a document given to a patient who wants to receive or request medical or dental care or evaluation at an Army Military Treatment Facility (MTF). The DD 689 may be used as evidence of communication between the attending AMEDD personnel and the unit commander of the military member. For example, to provide information about height and weight as required in AR 600-9 or to report to the patient's commander about any limitations when DA Form 3349 (Physical Profile) is unsuitable.
The latest version of the form - sometimes incorrectly referred to as the DA Form 689 - was released by the Department of Defense (DoD) on August 1, 2017 , with previous editions obsolete. An up-to-date DD Form 689 fillable copy is available for download below or can be found through the Executive Services Directorate website.
There are three types of personnel that can issue this form. The first one is the unit commander or their authorized representative. The second one is a confinement officer at a disciplinary facility or an authorized representative. The third is AMEDD personnel or an authorized representative if the patient must report directly to the MTF and medical limitations are set.
How to Fill Out DD Form 689?
Procedural guidelines and additional information can be found in the AR 40-66, Medical Record Administration and Healthcare Documentation, released in June 2008. DD Form 689 instructions are as follows:
- The form consists of three sections. The first one of the three parts will be completed by the patient or for the patient. The second section will be completed by the unit commander and the last one will be filed by a medical officer.
- The first section starts with a block dedicated to the soldier's medical condition. Individuals filling the form must select either "illness" or "injury". The "LOD" block has to be left empty. The information in the "Remarks" block will be filled in if the individual has duty status at time of condition (for example, Duty, Leave, AWOL, etc.), has non-battle injuries (the circumstances of how, when, and where injury occurred), has any specific requests to the MTF or if there is other information that may be helpful to the AMEDD personnel.
- The "Signature of Unit Commander" block will be signed by the commander.
- The second section will be completed by AMEDD personnel. The "LOD" block has to be left empty. The "Disposition of Patient" block has to be filled in depending on location of the patient. Tick "Duty" if the patient has returned to the unit for full duty without restrictions. Tick "Quarters" if the patient can't perform military duty until a medical officer indicates otherwise. Tick hospital if the patient is hospitalized.
- The "Sick Bay" block is not used by Army MTFs. "Not examined" must be explained in the "Remarks" block. "Other" can be ticked in special situations.
- The time and date the patient was released for the disposition must be written in the "Remarks" block. The "Signature of Medical Officer" block will be signed by a medical officer.
- When completed, the original of the DD Form 689 will be provided to the patient and the duplicate will be maintained by the patient's commander. Commanders may destroy a DD Form 689 when a temporary profile or quarters status has terminated.
