Fill Out DA Form 7809 in 2026
Capture care you received from a civilian provider, then sign and download a record your military doctor can add to your file.
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How to fill out a DA Form 7809
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Enter patient and provider info
Complete the Patient Data and Non-Military Provider fields for a valid form.
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What is a DA Form 7809?
DA Form 7809, Summary of Care by Non-Military Medical Provider, records treatment a Soldier receives from a civilian doctor instead of a military hospital. The civilian provider completes it, listing the services given, and must submit it within 7 business days. This matters because military medical staff need complete, accurate records to manage a Soldier's health, update medical profiles, and make sound decisions about readiness and deployment.
Key Takeaways
- Civilian providers file DA Form 7809
- Reports care given outside military hospitals
- Must be submitted within 7 business days
What is a DA Form 7809 used for?
This form records medical care a Soldier received from a civilian provider so it can become part of the Soldier's military medical record. It's used to:
- Document treatment given by a non-military provider for official military records
- Support continuity of care by helping providers track a condition over time
- Back up medical profile or duty-limitation decisions with provider notes, exam findings, and radiology reports
- Cover care received on leave, TDY, or overseas where military facilities aren't available
What information is required on a DA Form 7809?
Patient Data
Enter the Soldier's name, rank, and contact information for identification purposes.
Non-Military Provider/Facility Information
Enter the name and details of the civilian medical provider or facility that examined the patient.
Date of Care
Enter the date the medical care or exam took place.
Exam/History Section
Provider records the evaluation details and findings from the patient's exam and history.
Diagnosis
Provider enters the diagnosis and outlines the recommended treatment plan.
Medications Prescribed
Enter any medications prescribed to the Soldier during the visit.
Functional Activities
Provider notes the Soldier's ability to perform required military-related physical activities.
Provider Signature and Certification/Date
Provider signs to certify the assessment and enters the date of signing.
When is a DA Form 7809 due?
DA Form 7809 is due within 7 business days after civilian treatment. There's no fixed calendar date — the deadline runs from the treatment date itself. Hand-deliver it to your Primary Care Manager and Regional Care Coordinator, send copies to your unit chain of command, and keep one copy for your records.
Ready to fill DA Form 7809
Open DA Form 7809 here, complete each section, and download your finished copy before you close the tab.
When is a DA Form 7809 not required?
You can skip the form when care happens at a military treatment facility instead of a civilian office. It's also unnecessary if the soldier hasn't received any civilian medical evaluation or treatment, or if the condition is already recorded through other medical forms or records. In those cases, the summary adds no new information.
What does a DA Form 7809 form look like
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