Da 3365 Form – Fill Out and Use This PDF

Da 3365 Form PDF Details

What Is DA Form 3365?

DA Form 3365, titled "Authorization for Medical Warning Tag," is an official US Army medical document governed by Army Regulation AR 40-66 under the Office of The Surgeon General. Medical treatment facilities use this form to authorize and document the issuance of a medical warning tag to a patient who has a specific health condition, allergy, or treatment requirement that emergency responders must know about.

What the Authorization Form Records

When completing this form, the following details are captured:

• Patient name, rank, and military identification number
• Name and location of the issuing military treatment facility
• The specific medical condition, allergy, or risk displayed on the warning tag
• Signature and date of the authorizing medical officer confirming tag delivery
• Emergency contact names and phone numbers for the patient

Role of This Form in Army Medical Records

Under AR 40-66, all medical warning tags issued at Army facilities must be formally authorized through this pdf form. The completed authorization is filed as part of the patient's official Army health record, ensuring the chain of custody for the tag is properly documented. This standard process upholds the Army's commitment to patient safety and accurate medical documentation across all military treatment facilities.