DA Form 3761. Public Health Nursing Activities Report

The DA Form 3761, also known as the Public Health Nursing Activities Report, is a form used by public health nurses to document and report their activities. The purpose of this form is to track and record the various nursing activities performed by public health nurses in military healthcare settings. It serves as a means of ensuring accurate documentation of these activities and provides a record for tracking and evaluating the effectiveness of the services provided.

The form consists of several sections that capture important information related to the nursing activities. These sections include patient information, types of services provided, and any follow-up actions taken. In the patient information section, details such as name, rank, unit, and contact information are recorded. The types of services provided section allows nurses to document the specific services rendered, such as health assessments, immunizations, health education, or disease surveillance. Additionally, there is space provided to note any follow-up actions taken, including referrals or recommendations for further care.

When filling out the DA Form 3761, it is important to accurately record all relevant information. Nurses should ensure that patient details are correctly entered, and services provided are clearly documented. It is crucial to provide sufficient details about the nursing activities to facilitate proper evaluation and analysis. The form may be filled out by the public health nurse who performed the activities or by designated personnel responsible for compiling and reporting the data.

An example application of the DA Form 3761 would be in a military healthcare facility where public health nurses are responsible for providing preventive healthcare services to service members and their families. By using this form, nurses can document their activities, which can then be used for performance evaluations, resource allocation, and quality improvement initiatives. The form also serves as a valuable tool for tracking trends and identifying areas where additional support or interventions may be needed.