Da Form 5484 PDF Details

The Army Da Form 5484 is a form used to document Soldier's medical history. The form is also used to document medical and dental treatment and procedures undergone by the Soldier. The form must be completed by the Soldier's unit commander, healthcare provider, or dental care provider as appropriate. The information on the form helps commanders and healthcare providers make informed decisions about a Soldier's ability to continue to serve in the military. Incomplete or inaccurate information on the form can lead to misinformed decisions and may have negative consequences for the Soldier. It is important that the information on the form be complete and accurate so that commanders and healthcare providers can make informed decisions about a Soldier's health.

QuestionAnswer
Form NameDa Form 5484
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesarmy 5484, da form 5484 pdf, form 5484e pdf, da form 5484

Form Preview Example

MISSION SCHEDULE/BRIEF

For use of the form, see AR 95-1; the proponent agency is DCS, G-3/5/7.

DATE*

AC#*

PC*

PI*

CREWMEMBERS*

FLIGHT* COND

MISSION*

ETD /*

ETE

INITIALS

PC

BRIEFER

 

 

RAV*

MS*

REMARKS

LEGEND

FLIGHT CONDITION

1.

DAY

4.

IMC/SIM IMC

2.

NIGHT

5.

MULTI A/C

3.

ND

6.

TERRAIN FLT

 

MS

MISSION STATUS

CX-CANCELED

MC-MSN COMPLETE

 

NC-NOT COMPLETE AS BRIEFED; SEE REMARKS

* MANDATORY FOR ALL FLIGHTS

DA FORM 5484, JAN 2006

PREVIOUS EDITIONS ARE OBSOLETE.

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