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FORMS

DA Form 4700, Evacuation Patient Care Record (PCR)
1. BACKGROUND and PURPOSE
a. Pre-Hospital, Pre-Medical Treatment Facility (pre-MTF), or inter-MTF evacuation documentation of medical
interventions by ground vehicle and rotary-wing based medical personnel (CASEVAC/MEDEVAC) is critical to
ensuring continuity of care and providing meaningful analyses of medical interventions, techniques, tactics, and
procedures rendered during transport.
b. As medical providers, it is critically important to document patient care for follow on providers in order to achieve
the best patient outcomes. Additionally, well documented care can improve not only individual care, but as part of
a Process Improvement system, good documentation can identify places where casualty care can be improved on a
system-wide level.
c. Use of the DA Form 4700, Evacuation Patient Care Record (PCR) will allow for individual care improvement as well
as a method to enable appropriate patient care documentation. This will enable process improvement and quality
assurance for medical providers rendering care during patient evacuations. It is designed specifically for
documentation of care for all patients transported via ground or rotary-wing platforms in order to document all
evaluation and care provided for casualties.
2. POLICY
a. Commanders will ensure that all providers evacuating patients (to include both deployed and garrison operations,
regardless of AOR) use the PCR to document enroute care. Such care relates to both battle and non-battle injuries.
b. Once completed, the PCR will be entered into the patient’s medical record and the Department of Defense Trauma
Registry (DoDTR). Evacuation unit commanders must establish a clear process to ensure transmission of the medical
information recorded to the Joint Trauma System for data capture and entry into both the patients’ medical record
and the DoDTR.
c. Medical personnel providing care during evacuation will complete all entries as fully as possible.
d. All abbreviations authorized for use in DoD health records or DoD trauma registries may also be used on the PCR.
e. This PCR can be completed manually or electronically after care is provided and is designed to work equally well for
either. Manual entries may be made using a non-smearing pen or marker.
f. Free-text may be entered in any block despite appearance of drop-down menus.
g. Blocks where information is not applicable should be left blank or can be marked “N/A”
h. In an effort to accurately capture all patient care delivered, providers can document treatments relevant to their
transport performed by personnel prior to their assumption of patient care. This care should be documented in the
appropriate locations on the form with the time marked as “PTA” (Prior to arrival). (Ex: Ground medic places TQ on
RUE prior to MEDEVAC arrival. TQ location, type, etc. should be annotated with time as “PTA”).
i. This form should be completed within 72 hours upon completion of evacuation mission and submitted to JTS ASAP
following Medical Director review. Forms can be submitted via NIPR e-mail to: DHA.JBSA.j-3.List.JTS-
Prehospital@mail.mil
j. Additionaly JTS has the Military Enroute Care Registry (MERCuRY) (army.mil). Performance Improvement Events
Data worksheet. See instructions on worksheet. Complete the MERCuRY worksheet in conjunction with the DA 4700
before submitting to the Joint Trauma System.
(https://jts.amedd.army.mil/assets/docs/forms/MERCuRY_PI_28_Oct_2021.pd)
3. The most current version of the form, along with instructions for use can be found on the JTS site under the
documents tab, or at the following address:
https://jts.amedd.army.mil/index.cfm/documents/forms_after_action

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