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Get DA 5008 1981-2024

SSN OF PATIENT/SPONSOR HOSPITAL AND CLINIC IDENTIFICATION SERVICE AFFILIATION ARMY NAVY LOCATION OF PATIENTS MEDICAL RECORD CENTRAL FILES AREA OTHER (Specify) MARINE CORPS AIR FORCE OTHER (Specify) BENEFICIARY CATEGORY AD DEPN AD RET DEPN RET DEPN RET/DECD OTHER (Specify) PATIENT STATUS DATE AND TIME OF CALL INPATIENT OUTPATIENT NON-EMERGENCY EMERGENCY SUMMARY (Include complaint, diagnosis, instructions to patient) SIGNATURE OF PHYSICIAN/CARE PROVIDER CHECK IF CONTINUED ON REVE.

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