Download the form
Use DA Form 4159 when you need to request for medical care in a federal medical treatment facility outside department of defense. Full title: REQUEST FOR MEDICAL CARE IN A FEDERAL MEDICAL TREATMENT FACILITY OUTSIDE DEPARTMENT OF DEFENSE. Everything you need is on this page — the file, the entry rules, the routing. Edition 05/01/2009, status ACTIVE, unknown page(s), roughly unknown fields.
TSG is the proponent, AR 40-400 the prescribing authority. Read the directive only if something about your situation departs from the standard case. Otherwise the form is filled by the individual it describes, or by the records clerk keeping the file, and reviewed through the printed signature blocks.
PDF are available and the decision takes one second. Type your entries: fillable pdf. Write them: printable pdf. The published layout is common to both, so the format governs your method and nothing more.
Use a full pdf reader, not the browser viewer. Browser viewers display fields they cannot always save, and the loss shows up only when you reopen the file — type one entry, save, reopen, verify, then fill the rest.
No charge, no account, no email address. The file is the published document, distributed unaltered.
Start at the top and get the header exactly right. Official spelling of the name, identification number, unit, date. Everything downstream finds the record through those entries; nothing else on the page has that consequence.
Move between fields with tab; the build-time order follows the page and misses nothing. Click check boxes and option buttons, and expect an exclusive group to release the old choice when you set a new one. The trap is field width. Single-line fields do not wrap, so an overlong entry displays complete on screen and prints cut at the margin — put it in remarks or on a continuation instead. Mark inapplicable fields rather than leaving them blank, since an empty box carries no information about whether the question was read.
Sign last. An unsigned form is a draft whatever else is on it, and additional signatures — reviewer, approver, witness — follow printed block order with each signer dating the day they sign, not the day of preparation. Four faults account for most returns: a blank mandatory field, transposed digits in an identification number, day and month reversed in a date, and leftover entries in a working copy reused instead of a fresh blank. Read the form once from the top before releasing it.
The Privacy Act statement is read before the personal entries, not after. It gives the collection authority, the purpose, the routine uses and whether disclosure is mandatory or voluntary. Once filled, your copy is a personal record and gets stored and transmitted accordingly.
Routing follows AR 40-400 and nothing else — a named office, the unit administrative channel, or the individual's file, according to why the form was raised. Copy it before it leaves. Retention is fixed by the records schedule for the series, which local practice does not shorten or extend.
Look for associated forms by series and number. In the DA series, documents sharing a proponent or a governing directive tend to travel together, and anything referenced on the page normally submits alongside. Collect continuations, covers and transmittals in advance of sending.
Check the edition date before reusing a saved copy. Revisions come from the proponent without notice to you, and the printed date is the only version marker on the page. Already-submitted records under a superseded edition stand as filed; the change does not run backwards.
What is distributed here are reproductions of published Department of the Army documents. Independent site, no official standing, no forms of its own. Nothing on the page constitutes legal advice, and acceptance by any office is outside what can be stated. Put questions about entries, requirements or eligibility to TSG or your servicing administrative office.
Questions and answers
- What is DA Form 4159?
- REQUEST FOR MEDICAL CARE IN A FEDERAL MEDICAL TREATMENT FACILITY OUTSIDE DEPARTMENT OF DEFENSE
- Which edition is current?
- 05/01/2009
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)