You need DD Form 7A, and this page gives you the blank plus the steps for handling it. Start with what the form does: Report of Treatment Furnished Pay Patients Outpatient Furnished (Part B). Its official title is DD Form 7A, Report of Treatment Furnished Pay Patients - Outpatient Treatment Furnished (Part B), August 1976.
Next, check the edition. You want not stated, currently carried as not stated by the publisher. Then confirm the form applies to you — this is a Department of Defense form, so you use it whether you serve in the Army, Navy, Air Force, Marine Corps, Space Force or Coast Guard under Defense jurisdiction.
After that, turn to timing. The requirement comes from not stated; the form is maintained by not stated. Local implementing instructions fill in the dates, so check with the office that will receive your copy.
Finally, decide how you will complete it. You can type into a fillable file or print a blank and write by hand, and the rest of this page walks you through both paths in order.
Begin at the top and move down. Enter your identifying data first, then the body of the form, then the signature block. The sequence is printed in that order because entries below frequently follow from entries above.
Check the edition before you type a word. The date appears on the face of the form; it should read not stated. When it does not, discard the file and take a fresh copy from this page. Department-level revisions replace the blank across all services simultaneously, which means an old printout can be out of step everywhere.
Look up an unclear item on the form face before anywhere else, then in not stated. Should the two texts conflict, the directive is the one you follow.
Download the form
First, look at what you can download. The set covers PDF, the form runs 1 pages, and you will complete roughly 94 fields.
Whichever you pick, you pay nothing — every format here is a free download. One last tip: open your pdf in a desktop reader rather than in a browser tab, because browser viewers sometimes drop the interactive fields you need.
What the form asks for
- Report control symbol.
- 1. Installation providing treatment (name and address).
- 2. Month and year covered by this report.
- 3. Category of patients.
- 4. Authority for admission.
- 5. Name (Last, first, middle initial) and social security number, line 1.
- 6. Military grade.
- 7. Organization.
- 8. Diagnosis.
- 9. Dates treated.
- 10. Number of days treated.
- 5. Name and social security number, line 2.
- 6. Military grade.
- 7. Organization.
- 8. Diagnosis.
- 9. Dates treated.
- 10. Number of days treated.
- 5. Name and social security number, line 3.
- 6. Military grade.
- 7. Organization.
- 8. Diagnosis.
- 9. Dates treated.
- 10. Number of days treated.
- 5. Name and social security number, line 4.
Now that it is complete, send it where not stated or your local procedure says it goes. Before you do, make yourself a copy — scan it or save the file elsewhere. It costs you nothing and saves you the whole exercise if the original goes missing.
If the form points you to another document, you can find it by number alone. DD numbering runs across the whole Department, so you do not need to work out which service issued it — one number, one form, everywhere.
Here is where people go wrong. They see a number in an instruction and download whichever form matches it. But DA and DD are separate systems — Army-specific in one case, Department-wide under not stated in the other — so check which series you were sent to before you take the file.
Do not archive this file and reuse it in a year. Forms are reissued as directives are revised, as data requirements shift, and as statutory notice text is amended. Your protection is simple: download fresh each time and confirm the edition date.
Finally, understand the limits of what you have read. This page distributes a published Department of Defense form and describes how to fill it out. It does not give legal or procedural advice, and it cannot promise any outcome for your particular case. For that, contact not stated, your administrative office, or the authority identified in not stated.
Questions and answers
- What is DD Form 7A?
- DD Form 7A, Report of Treatment Furnished Pay Patients - Outpatient Treatment Furnished (Part B), August 1976
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?