Download the form
Use DA Form 4254 when you need to request for private medical information. Full title: REQUEST FOR PRIVATE MEDICAL INFORMATION. Everything you need is on this page — the file, the entry rules, the routing. Edition 02/01/2003, status ACTIVE, unknown page(s), roughly unknown fields.
Two references decide everything about your use of it: TSG maintains the content, AR 40-66 sets the trigger and the routing. Consult the directive when your case is not routine; otherwise the printed blocks tell you enough. The person named in the entries fills it, or the administrative office holding the file does it for them.
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.
Save the download and open it in a dedicated reader. That single step prevents the common failure: an in-browser viewer accepts your typing and discards it at tab close. Confirm with one field and one save cycle before committing the whole form.
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.
Privacy Act statement first, personal entries second. The notice covers who is authorised to collect, why, who else routinely sees it, and whether you must answer. After completion the file carries personal data and is stored and sent under the corresponding safeguards.
The prescribing directive names the destination; office custom does not. Depending on the case that means a specific office, the unit administrative channel, or the personal record. Keep a copy first, because the original does not come back. Retention runs on the applicable records schedule.
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 4254?
- REQUEST FOR PRIVATE MEDICAL INFORMATION
- Which edition is current?
- 02/01/2003
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA