DA Form 4029. Patient`s Clearance Record

DA Form 4029, also known as the Patient's Clearance Record, is a form used the Department of the Army to document the medical clearance status of a patient. This form is typically used in military healthcare facilities to track and verify that a patient has met all necessary medical requirements before being cleared for specific activities or assignments.

The form consists of sections where healthcare providers can record the patient's personal information, medical history, examination results, immunization records, and any other relevant medical information. It may also include sections for documenting specific clearances, such as dental clearance mental health clearance.

Important fields in this form include the patient's personal information, medical history, examination findings, dates of clearance, and signatures of the healthcare provider and the patient. It is crucial to accurately fill out all required information to ensure accurate record of the patient's medical clearance status.

Application Example: DA Form 4029 is used when a military service member or civilian employee requires medical clearance for certain activities or assignments, such as deployment, training exercises, or specialized duties. The form is completed by healthcare providers who assess the patient's medical fitness and determine if they meet the necessary requirements for clearance.

Related Forms: There may not be direct alternatives to DA Form 4029, as it is specifically designed for documenting patient clearance in the Department the Army. However, other medical forms, such as medical examination forms or medical history forms, may be used conjunction with DA Form 9 to provide a comprehensive medical assessment.