A dd form 28071 is a department of defense form is used for gathering medical information for applicants to military service. Adverse reaction to serum, food, insect stings or medicine l. Soldiers that exceed htwt on physical must include a da form 55005501. Dd form 2860 this form is used to apply for crsc from the dod. Fill out the report of medical history online and print it out for free. Download a pdf version of the dd form 2808 down below or find it on the u. All items noted below are required and absence will be sufficient cause for not being allowed to continue with dive training. Dd form 2808 fill out and sign printable pdf template signnow. Dd form 200, financial liability investigation of property loss, october 1999.
If any portion of your service was under the federal employees retirement system, use standard form sf 3102. Fill out the form in its entirety, making sure to document any allergy or medication information in blocks 9 and 10. Dd form 28071, report of medical history, october 2003. Dd form 28071 is often used in dd 2807 forms, dd forms, u. This form is used to collect information on your physical and mental health status before a deployment. A dd form 28071 is a department of defense form which is used to gather medical information for applicants who need to accept military service. If dental examination not done by acceptable dental officer, explain in item 44. Under the training resources tab select dd 2807 and print out blank form. If this message is not eventually replaced by the proper contents of the document, your pdf viewer may not be able to display this type of document.
Replaces the existing medical prescreen form dd form 28072, aug 2011. Dd form 2808, report of medical examination, october 2005 jrotc. Dd form 294 this form and va form 3288 are used to apply to the pdbr. Contact the department of defense forms manager for further details if this access is required. Dd form 2808 fill online, printable, fillable, blank. Dod instruction 6040 washington headquarters services. This form is to be completed by each individual who requires medical processing in accordance with department of defense instruction dodi. Download a blank fillable dd form 2808 report of medical examination 2005 in pdf format just by clicking the download pdf button.
If the dependent does not have their passport, leave blank and the sao will complete the entry. Its used by meps during the meps medical examination. Use this stepbystep guide to fill out the navy dd form 2808 quickly and with perfect accuracy. Dd forms 25002999 updated 02192020 form availability. Dd form 2808 download fillable pdf or fill online report of. Dd form 2808 ensure form is dated, physical type is ocs or commissioning and md or do signs in appropriate block 8184. Department of defense, army forms, business, united states federal legal forms and united states legal forms. Download fillable dd form 28071 in pdf the latest version applicable for 2020. If the form number does not have a hyperlink, the form is not available electronically.
The directives division administers and operates the dod issuances program, the dod information collections program, dod forms management program, gao affairs, and the dod plain language program for the office of the secretary of defense. Dd form 28071, aug 2000 page 2 of 3 pages last name, first name, middle name suffix social security number b. My medical history is required to be on the dd28071. Page 1 of 9 instructions for completing dd form 28072, accessions medical history report. Dd form 28072, medical prescreen of medical history report. Dd form 2808 report of medical examination, referred to in paragraphs 3. Laws calm legal forms guide a dd form 2807 one is a department of defense form used for gathering medical information for applicants to military service the form is used by military physicians to determine if an applicant can be accepted or should be disqualified on medical grounds the dd form 2807 one is available on the department of defense documentation website or can be supplied to. Sexually transmitted disease syphilis, gonorrhea, chlamydia, genital. The way to complete the online dd form 2808 on the internet. For further guidance refer to the manual of the medical department manmed, navmed p117, chapter 15. A dd 2808 form will include the date of the exam, the name and personal information of the party being examined, and evaluations from the medical examination. Seal swcc fleet conversion package checklist navy seal. Military physicians determine if an applicant can be accepted or should be disqualified on medical grounds with the help of it. Nervous trouble of any sort anxiety or panic attacks e.
Pdf, reserve component survivor benefit plan rcsbp election certificate. My medical history is required to be on the dd28071 report of medical. Be sure to name in this form all persons you wish to designate as beneficiaries of any lump sum. Dd form 28071 download fillable pdf or fill online report. Va separation health assessment for service members.
Component coast guard privacy act statement authority. Completed dd form 2808 example as well as s formswift seo pages assets images documents dd 2808 dd 2808 s le in addition. The shpe participation quarterly report, described in paragraph 3. Dd form 26481, preseparation counseling checklist for. The way to complete the online dd form 2808 july 2019 on the internet. Army publishing directorate army publishing directorate. Adobe reader or any alternative for windows or macos are required to access and complete fillable content. Create a free dd 2808 form in minutes with our professional document builder. Additional questions have been added to improve its usefulness to the accessions medical prescreening process. The dd forms 28071, 28072, and the 2808 connect the military recruiters office, meps, and the applicant seeking to join the military to one another by disclosing medical history information of the recruit.
The dd forms 28071, 28072, and the 2808 connect the military recruiters office, meps, and the applicant seeking to join the military to one another by disclosing. Dd form 2808, oct 2005 page 1 of 3 pages clinical evaluation check each item in appropriate column. Not acceptable class dd form 2808, oct 2005 02 may 07 dod exception to sf 88 approved by icmr, august 3, 2000. Dd form 28072, accessions medical prescreen report. Department of the navy don disability evaluation manual ref. Use this stepbystep instruction to complete the 2808 form 20052019 quickly and with perfect precision. Notice of appeal this form is used to appeal to the us court of appeals for veterans claims. Pdf, data for payment of retired personnel dd form 26565. This designation of beneficiary form is used to designate who is. The form, often mistakenly referred to as the da form 2808, is a military form used by and within the u. Dd form 2808 july 2019 fill out and sign printable pdf. Examineeapplicantwill be used by some military facilities. The form is designed to assist recruiters in the medical prescreening of applicants. Dd form 2808 download fillable pdf or fill online report.
The advanced tools of the editor will direct you through the editable pdf template. Loss of memory or amnesia, or neurological symptoms 17. Laboratory tests may be required, as well as an eye exam, hearing test, and dental exam. Aug 31, 2003 dd form 28071, aug 2000 page 2 of 3 pages last name, first name, middle name suffix social security number b. Date of inter railway own request transfer application form 2011. Dd form 2808 fill out and sign printable pdf template. Jan 24, 2008 dd form 2808, oct 2005 page 1 of 3 pages clinical evaluation check each item in appropriate column. Diverbudss medical screening questionnaire, along with the dd form 2808, report of medical examination with all labs, ekg, and xray results printed out with normal ranges and dd form 28071 report of medical history, to naval diving and salvage training center or navy special warfare. Do not fill out this form until you have read the information and instructions below. Dental defects and disease acceptable class dd form 2808 oct 2005 please explain. The information collected on this form is used to assist dod physicians in making determinations as to acceptability of applicants for military service and verifies disqualifying medical conditions noted on the prescreening form dd 28072. Dod medical forms 2807 and 2808 used by recruiters meps. Applicants to jrcostep instructions for completion of dd form 28071. Important the filing of this form will completely cancel any designation of beneficiary under the civil service retirement system you may have previously filed.
Dd form 28071 report of medical history legal forms. Dd form 2058, state of legal residence certificate, february 1977 author. Dd form 2808, jan 2003 page 1 of 3 pages clinical evaluation check each item in appropriate column. The form is used by military physicians to determine if an applicant can be accepted or should be disqualified on medical grounds. Dd form 28071, oct 2003 dod exception to sf 93 approved by icmr, august 3, 2000.
The primary collection of this information is from individuals seeking to join the armed forces. Contact the department of defens e forms manager for further details if. Instructions use this form only if you are or were covered by the civil service retirement system. Dd form 28072, medical prescreen of medical history. Dd form 28071 download fillable pdf or fill online report of. General instructions for completing medical examination forms. Current dd28071 report of medical history no older than one year will be required for assimilation, permanent promotion, and long term training. Dd form 2808 or the report of medical examination is a form issued by the u. An additional collection of information using this form occurs when a medical evaluation board is convened to determine the medical fitness of a current member and if separation. This form has not been set up to work with a texttospeech reader. To download a document, rightclick on the link and select save target as. Fillable dd form 2808 report of medical examination 2005. To obtain hard copies of current forms not available in electronic format, please contact your own military service or dod component forms management officer. Dd form 2808, report of medical examination, january 2003.
The individual completing the dd form 28072 will submit the form, at a minimum, 1 processing day in advance to the meps projected to process the individual. The dd form 28071 is available on the department of defense documentation website or. Preseparation counseling checklist name last, first, middle initial ssn for reserve component service members dd form 26481, jun 2005 section v remarks attach additional pages if necessary page 3 of 3 pages. Dd form 2808 is used by the meps medical staff to document the medical examination.
The advanced tools of the editor will lead you through the editable pdf. Pdf, application for identification carddeers enrollment dd form 2656. Va separation health assessment for service members factsheet. Dd form 2808 or the report of medical examination is a form used by the military entrance processing station meps medical staff to obtain the health related. This version of the adobe acrobat is not compatible with the apd website. Ncpb form 18507 this form is used to contest the navy or marines decision on crsc.
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