DA Form 4159. Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense

The DA Form 4159, also known as theRequest for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense," is used to request medical care for military personnel and their dependents in a federal medical treatment facility that is not part of the Department of Defense (DoD).

The form consists of several sections that need to be completed accurately. The first section requires the requester to provide personal information such as name, rank, social security number, and contact details. The second section focuses on the patient's information, including their name, relationship to the requester, and medical condition.

Important fields to consider when filling out this form include the reason for seeking medical care outside the DoD, the specific medical treatment required, and any supporting documentation or medical records that should accompany the request.

The parties involved in this form are the military personnel or their dependents who require medical care and the authorized personnel responsible for processing and approving the request.

Application examples and use cases for the DA Form 4159 include situations where specialized medical treatment is needed, and the DoD medical facilities do not have the necessary resources or expertise. It may also be used when military personnel are stationed in remote locations without access to DoD medical facilities.

An alternative form that may be used in certain circumstances is the DD Form 1251, which is specifically designed for requesting medical care outside the United States. However, the DA Form 4159 is primarily used for requesting medical care within the United States.