DA Form 7809: Fill Out Online in 2026

DA Form 7809, Summary of Care by Non-Military Medical Provider, records medical care a Soldier receives outside a military hospital. A civilian doctor or other non-military health care provider completes the form. The provider lists the services given during the visit so the Army can add the details to the Soldier’s medical record.

The Soldier must submit the completed form within seven business days after civilian treatment. Missing this deadline may delay the creation or update of a medical profile. That delay can affect the Soldier’s readiness status and ability to deploy. Timely submission helps keep military health records accurate and complete.

DA Form 7809 is used when a service member receives care from a non-military medical provider. It records the diagnosis, treatment, prescriptions, and follow-up needs from that visit. This gives the military healthcare team the details needed to continue the member’s care and keep medical records complete.

The DA Form 7809 Army process also helps officials assess a Soldier’s physical and functional limits. The reported medical facts may support a temporary or permanent profile and help set duty limits based on the Soldier’s condition.

DA Form 7809 is issued by the U.S. Department of the Army. The Army released this version on June 1, 2019. You can get the official blank form through Army publications sources.

PDFLeader also has a blank DA Form 7809 fillable copy pre-loaded in our browser-based editor, so you do not need to find and download a template elsewhere. PDFLeader helps you fill out and download the completed form for future use, but it does not file or submit it.

After you download the completed DA Form 7809, give it to the service member’s Primary Care Manager and unit or chain of command within the required timeframe. These offices route it for inclusion in the Service Treatment Record. If local guidance names a Regional Care Coordinator, route the form through that coordinator as directed.

No official Department of Defense instructions identify a dedicated online portal or central mailing office for this form. Delivery is usually in person to medical or unit staff, or through normal unit channels. Ask your unit’s administrative or medical office whether it requires hand delivery, internal routing, or another local method.

The Soldier completes Part I, Patient Data. This section asks for identifying and administrative details that the patient must provide. The civilian medical provider completes and signs Parts II–V. These parts cover clinical care, diagnoses, and treatment details that the provider can confirm.

After completion, Army administrative staff review the supplied information, enter it into the proper records when required, and route the form to the right medical personnel. Military medical facilities, authorized healthcare providers, and other personnel involved in the Soldier’s care then use the information to support treatment decisions and maintain care records.

DA Form 7809 does not state which signature method to use. Army records policy may require a handwritten signature or an authorized DoD PKI/CAC digital signature. A simple electronic signature may not be accepted for official Army records. You can add an electronic signature with PDFLeader and download the completed form. If a digital or wet signature is required, complete that step elsewhere. Check Army Publishing Directorate for the latest updates before submission. PDFLeader does not submit the form.

Have the patient’s Name (Patient), Home Address, DoD ID Number, Rank and Grade, Date of Birth, and Primary Phone Number, including the area code. You also need the patient’s Component and VA Disability Benefits status. If the answer is “Yes,” gather all covered medical conditions and the overall rating %.

The non-military provider should have their name and contact information, the date of care, diagnoses, medications prescribed, a summary of the care provided, and details about follow-up care. Keep the related medical record on hand to confirm these facts. The provider must also complete the certification that the information is true and accurate. No separate Army instruction sheet provides a line-by-line field key, so check the current DA Form 7809 PDF from Army Publishing Directorate before completion.

DA Form 7809 is due within seven business days of the civilian care encounter. This deadline helps ensure that medical concerns affecting your physical capacity, deployability, or duty performance reach the right military contacts without delay.

If you submit the form for a profile request, it must be dated within the past 60 days. You must deliver the completed form to your Primary Care Manager and Regional Care Coordinator. You must also provide it to your unit chain of command.

Care received at a military treatment facility (MTF) does not require DA Form 7809. You also do not need to complete the form if you had no medical evaluation or treatment from a civilian provider.

The form may also be unnecessary if other forms or medical records already document your condition and care. Current guidance does not set a dollar or time threshold for these cases. Check with your unit or medical staff if you are unsure whether your existing records are enough.