DD Form 7. Report of Treatment Furnished Pay Patients Hospitalization Furnished (Part A)

DD Form 7 - Report of Treatment Furnished Pay Patients Hospitalization (Part A) is utilized by medical facilities within the Department of Defense to document and report the medical treatment provided to patients who are eligible for care and are paying for the services received.

The form consists of sections where medical personnel record detailed information about the patient, the medical services provided, and the associated costs. The form captures patient identification details, treatment dates, procedures conducted, medications administered, and charges incurred.

Important fields in this form include patient identification data, a comprehensive list of medical services with corresponding codes, treatment dates, and cost breakdown. Accurate completion of this form is crucial as it ensures proper billing and transparency in the medical treatment provided.

Application Example: A military member's dependent undergoes surgery at a military medical facility and is classified as a pay patient. The medical staff completes DD Form 7 to document the surgery, anesthesia, and any post-operative care. Accurate information ensures that the patient is billed appropriately and the medical facility is properly reimbursed for the services rendered.

Additional documents needed for completing the form include medical records related to the treatment provided. DD Form 7A serves as the outpatient counterpart of this form.