Download the form
DA Form 7809 handles one job: summary of care by non-military medical provider. The official title is SUMMARY OF CARE BY NON-MILITARY MEDICAL PROVIDER. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 12/01/2023, status ACTIVE, running 1 page(s) with about 130 fields to complete. This edition is superseded — pull the newer one unless your record was already executed on this version.
Two references decide everything about your use of it: TSG maintains the content, PAM 40-502 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.
The formats are PDF, and the choice comes down to keyboard or pen. Fillable pdf for typing — live fields, tab order, saved entries. Printable pdf for handwriting — same page, no interactive objects, print it blank. Content is identical; only entry method differs.
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.
Free, unregistered, unmodified. What arrives is what the publisher released.
What the form asks for
- AGR
- APFT_Test_Now_No
- APFT_Test_Now_Yes
- Additional_Medical_History
- Anticipation_Date
- Attachment_Button
- Brief_Summary
- Component_AC
- Component_AGR
- Component_ARNG
- Component_IDT_M_Day
- Component_ING
- Continuation
- CurrentPage
- DOD_ID_Number
- Date2
- Describe_Injuries
- Diagnosis
- FAX_Number
- Follow_Up
- Form_Rectangle
- Functional_Limitations_Permanent
- Functional_Limitations_Temporary
- Funtional_Activities_No1
Header first, always. Name as your official records spell it, identification number, unit, date of preparation — these four index the finished record, and an error in them hides the document from anyone searching for it later. The substantive blocks can wait thirty seconds.
Tabbing beats clicking for coverage. The order was set at build time and tracks the page layout, so following it leaves no gaps. Boxes and buttons are clicked; where options are exclusive, one selection cancels another by design. Watch field width on long entries: one-line fields have no wrap, and what runs past the edge disappears in print though the screen still shows it. Move that text to remarks or a continuation. Never leave an inapplicable field empty — enter the nil mark, because a reviewer cannot distinguish a skipped question from a considered answer.
The signature closes the form and nothing precedes it. Draft status holds until it is applied, by hand or by an accepted electronic method. Countersignatures go in printed order, each dated at signing. Then one final read from the top, looking for the four recurring defects: empty mandatory fields, swapped digits in identification numbers, day-month inversion in dates, and residue from a reused file that goes forward as though intended.
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.
Send it where the directive says: the office it names, the unit administrative channel, or the individual's file. Take your copy before submission. How long the record is held comes from the schedule for the series, not from the office holding it.
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.
These are reproductions of published Department of the Army documents, offered for download. The site is independent, connected to nothing official, and issues no forms of its own. Nothing here is legal advice and no statement is made about acceptance by any office. Questions about an entry, a requirement or eligibility go to TSG or your servicing administrative office.
Questions and answers
- What is DA Form 7809?
- SUMMARY OF CARE BY NON-MILITARY MEDICAL PROVIDER
- Which edition is current?
- 12/01/2023
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, PDF
Publisher notes
- PRIVACY ACT STATEMENT