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

DD Form 7A - Report of Treatment Furnished Pay Patients Outpatient Furnished (Part B) is employed by Department of Defense medical facilities to record and report outpatient medical treatment given to patients who are eligible for care and are responsible for the costs.

The form comprises sections where medical staff input patient details, the provided medical services, and associated expenses. The form covers patient identification information, dates of treatment, medical procedures, medications dispensed, and charges incurred.

Key fields in this form encompass patient identification details, a comprehensive list of outpatient medical services with corresponding codes, treatment dates, and cost breakdown. Completing the form accurately is essential to ensure proper billing and transparency in the outpatient medical treatment provided.

Application Example: A retired military service member seeks physical therapy at a military medical clinic as a pay patient. DD Form 7A is used to document the therapy sessions, exercises performed, and any applicable charges. Proper completion of the form guarantees accurate billing and reimbursement.

Additional documents required for form completion include medical records pertinent to the provided treatment.