DA FORM 5669 – Preventive Medicine Counseling Record

DAFORMS.NETDA FORM 5669 – Preventive Medicine Counseling Record

  1. The DA Form 5669 is a form prescribed by the U.S. Department of Health and Human Services (HHS) that records preventive medicine counseling services provided to patients.
  2. The form is used to track the extent and quality of counseling services provided to patients, and it should be completed and retained by healthcare providers who provide preventive medicine counseling services.
  3. The form is used only to record counseling provided and is not used for billing or other financial purposes.
  4. The form contains instructions for completing the form, including instructions regarding the period covered by each entry.
  5. The form is signed by the counselor and is notarized.
  6. The form contains an identification that shows that the counseling was provided to an individual who requested mental health services.
  7. The form contains a description of the counseling provided to the individual.
  8. The form contains a certification that the information contained on the form is true and correct to the best of the counselor’s knowledge.

Download DA FORM 5669 – Preventive Medicine Counseling Record

Form Number DA FORM 5669
Form Title Preventive Medicine Counseling Record
Published 07/01/2012
Prescribing Pub AR 600-110
File Size 46 KB

Download DA FORM 5669 [.PDF]

What is a DA FORM 5669?

DA FORM 5669 is a document that is used by the United States Army to keep track of various types of equipment. The form is also known as an Equipment Utilization Record and it is used to record information about the maintenance, repair, and usage of different types of equipment. This form is an essential tool for ensuring that all Army equipment remains in top working order and can be easily accessed when needed.

The DA FORM 5669 contains important information about the equipment such as its model number, serial number, date acquired, and location. It also includes information about any repairs or modifications that have been made to the equipment since it was first acquired. This document serves as a valuable resource for Army personnel who need to know what type of equipment is available at any given time.

Where Can I Find a DA FORM 5669?

If you’re a member of the US military or a civilian employee of the Department of Defense, then you may find yourself in need of various forms and documents. One such document is DA Form 5669, also known as the Quality Control Inspection Record. This form is used to document inspections and tests on equipment, facilities, or materials.

So where can you find this important form? The easiest way to obtain a DA Form 5669 is through your unit’s supply office. They should have copies available for distribution to those who need them. Additionally, many bases and installations have a centralized Forms Management Program that provides access to commonly used forms like this one.

If you’re unable to get the form through these channels, there are other options available. You can try contacting your unit’s logistics officer or requesting it through an online service like Army Publishing Directorate.

DA FORM 5669 – Preventive Medicine Counseling Record

DA Form 5669 is an important document used by the US Army to record and track preventive medicine counseling for soldiers. The form is designed to help military personnel maintain good health and prevent the spread of disease. It provides a comprehensive record of all preventive medicine measures taken, including immunizations, tests, and other medical procedures.

The form is an essential tool for healthcare providers in the military as it helps them keep track of soldiers’ medical history and provide better care. It also enables them to identify potential health risks early on and take necessary actions to minimize or eliminate them. Moreover, DA Form 5669 can help soldiers stay informed about their health status, so they can make more informed decisions concerning their physical well-being. Overall, DA Form 5669 plays a vital role in ensuring that military personnel remains healthy throughout their service period.

DA FORM 5669 – Example

DA FORM 5669 - Preventive Medicine Counseling Record