DA Form 3705. Receipt for Outpatient Treatment/Dental Records

Form DA 3705 is a receipt form used to acknowledge the receipt of outpatient treatment or dental records by a patient within a military medical facility. This form helps ensure that patients receive their medical records and serves as proof of receipt.

The form consists of sections where the patient's personal information, treatment details, and signature can be recorded. It may include columns or tables to record the date of treatment, type of treatment, and any remarks or notes.

Important fields in this form include the patient's personal information, treatment details such as the date and type of treatment, and the patient's signature. Accurate completion of the form is necessary to provide proof of receipt and ensure proper management of outpatient treatment or dental records.

Application Example: Military medical facilities can use this form to acknowledge the receipt of outpatient treatment or dental records by patients. The form should be completed with accurate and complete information about the patient, treatment details, and the patient's signature. This form helps ensure that patients receive their medical records and facilitates proper record-keeping within the military healthcare system.

Related Forms: Depending on the specific context or purpose, other forms related to medical record management, patient documentation, or outpatient treatment may exist within the military medical system.