Patient Progress Report (Ppr) - Apd - Army
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1
2PATIENT PROGRESS REPORT (PPR)
REQUIREMENTS CONTROL
SYMBOL CSGPA-1400
For use of this form, see DA PAM 600-85; the proponent agency is ODCSPER
SEE FOLLOWING PAGE FOR PRIVACY ACT STATEMENT
SECTION I - IDENTIFICATION
1. DATE OF REPORT (YYYYMMDD)
4. REASON FOR REPORT (Check one)
A. Patient PCS/Reassignment (Complete sections II and VII)
2. PATIENT IDENTIFICATION
B. Change in Diagnosis (Complete section III)
C. Change Basis for Enrollment (Complete section IV)
D. RTF Enrollment/Discharge (Complete section V)
3. SERVICE AREA CODE
E. Progress Evaluation (Complete section VI)
F. Release from Program (Complete sections VI and VII)
SECTION II - PATIENT PCS/REASSIGNMENT
5. GAINING SERVICE AREA FOR PCS LOSS
6. NEW PATIENT MACOM FOR PCS GAIN/ REASSIGNMENT
SECTION III - CHANGE TO DIAGNOSIS
(Physician Use Only)
7a. PHYSICIAN DIAGNOSIS (List primary diagnosis first)
7b. DIAGNOSIS CODE
8. TYPED NAME AND GRADE OF PHYSICIAN
9. SIGNATURE OF PHYSICIAN
SECTION IV - ENROLLMENT
10a. CHANGE TO BASIS FOR ENROLLMENT
10b. PRIMARY
10c. SECONDARY
10d. TERTIARY
SECTION V - INPATIENT RTF ENROLLMENT
11. DATE OF ADMISSION (YYYYMMDD)
12. RTF CODE 13. NAME OF FACILITY
14. DISCHARGE DATE (YYYYMMDD)
SECTION VI - IN PROGRESS EVALUATION
15. COUNSELOR'S ASSESSMENT OF
16. COUNSELOR'S RECOMMENDATION (Check one)
17. COMMANDER'S APPRAISAL OF
PROGRESS
PERFORMANCE
A. Continue Treatment
B. Terminate Treatment, Retain on Active Duty
S. Satisfactory
C. Terminate Treatment, Separate
U. Unsatisfactory
G. Good
F. Fair
P. Poor
18. COMMANDER'S APPRAISAL OF
19. COMMANDER'S DECISION (Check one)
CONDUCT
A. Continue Treatment
B. Terminate Treatment, Retain on Active Duty
S. Satisfactory
U. Unsatisfactory
C. Terminate Treatment, Separate
SECTION VII - RELEASE FROM PROGRAM
20. REASON FOR RELEASE FROM PROGRAM (Check one)
A. Program Completed, Returned to Duty
F. Patient Refuses Further Treatment
B. Completion of Tour of Duty/Leaving Active Federal Service
G. Commander Terminated the Enrollment Against Medical Advice
C. Separation/Termination as an Alcohol/Drug Abuse Rehab Failure
H. Erroneous Enrollment
D. Separation/Termination, Misconduct - Abuse of Illegal Drugs
X. Other (USAF/NAVY PCSing, death confinement, etc.)
E. Separation/Termination for Other than Alcohol/Drug Reasons
21. COMMANDER'S ASSESSMENT
22. NAME, GRADE OF COMMANDER
23. SIGNATURE OF COMMANDER
S. Success
F. Failure
24. SIGNATURE OF COUNSELOR
25. NAME, GRADE OF CLINICAL DIRECTOR
26. SIGNATURE OF CLINICAL DIRECTOR
APD LC v1.00
DA FORM 4466, NOV 2001
DA FORM 4466-R, NOV 1991, IS OBSOLETE
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