DA Form 5195. Health Data

DA Form 5195, the Health Data form, serves as a comprehensive record of an individual's health history, enabling healthcare providers to make informed medical decisions and provide appropriate care. This form is an essential tool for maintaining accurate health records within the Department of the Army's medical system.

The form consists of sections where individuals provide personal and family medical history, allergies, medications, immunization records, and information about existing medical conditions. Additional sections may include surgical history and contact details of emergency contacts.

Important fields in this form include personal and family medical history, allergies, current medications, and existing medical conditions. Accurate completion of this form is crucial for ensuring that healthcare providers have access to a comprehensive health record, which aids in diagnosis, treatment planning, and medical decision-making.

Application Example: A soldier schedules a medical appointment and completes DA Form 5195 before the visit. By providing detailed information about their medical history, allergies, and current medications, the soldier helps the healthcare provider make well-informed decisions regarding their care.

No additional documents are typically required to complete this form, as it captures all necessary health-related information.

Alternative forms for medical history might exist, but DA Form 5195 is specifically tailored for the Department of the Army's health data requirements, ensuring accurate record-keeping and healthcare provision.