Adverse reaction to serum, food, insect stings or medicine. Fill out, securely sign, print or email your sf 428 form instantly with signnow. Public health service\ngeneral instructions for completing medical examination forms dd 28071 report of medical history and dd 2808 report of medical examination. This form is not an authorization or consent to use or disclose your health information. Dd form 28071, report of medical history, 20160516 draft author. The form is designed to assist recruiters in the medical prescreening of the individual completing the dd form 28072 will submit the form, at a minimum, 1 processing day in a additional information needed see dd form 2808. 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. Military physicians determine if an applicant can be accepted or should be disqualified on medical grounds with the help of it.
Its used by meps during the meps medical examination. Dd form 28071, report of medical history, with instructions on how to complete. Army da administrative publications and forms by the army publishing directorate apd. The form is a report of medical examination, and it is typically used at a military entrance processing station for. Diverbudss medical screening questionnaire, along with the dd form 2808, report of medical examination with all labs, ekg, and xray results. To download a document, rightclick on the link and select save target as. Dd form 28071, oct 2003 dod exception to sf 93 approved by icmr, august 3, 2000.
Use dental form if completed normal arch mild asymptomatic by dentist. Dd form 28071, report of medical history, october 2003. If dental examination not done by dental officer, explain in item 44 dd form 2808, oct 2005 dod to approved by icmr. General instructions for completing medical examination forms.
The latest technologies high quality electronic pubs and forms view u. Dd form 26481, preseparation counseling checklist for reserve component service members released from active duty, june 2005. Clinical evaluation check each item in appropriate column. 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. To assess your state of health after deployment in. Pes cavus moderate not acceptable class pes planus severe symptomatic dd form 2808, oct 2005. Adobe reader or any alternative for windows or macos are required to access and complete fillable content. Dd form 2808 july 2019 fill out and sign printable pdf. Dd form 28071 oct 2018 page 2 of 3 pages last name, first name, middle name suffix social security number b. This form is to be completed by each individual who requires medical processing in accordance with army. Dd form 2697 report of medical assessmentfor vai have documented all current or active medical conditions from 2807 2808. Sf 428 fill out and sign printable pdf template signnow. Nervous trouble of any sort anxiety or panic attacks. Dd form 2808 and 2807, oct 2005 will have a statement to the effect that the soldier is or not qualified to attend airborne training in block 77 on the new dd form 2808.
Dd form 28071 download fillable pdf or fill online report. This form has not been set up to work with a texttospeech reader. Dod exception to sf 88 approved by icmr, august 3, 2000. Medical screening for diving duty, eod and buds applicants. Laboratory tests may be required, as well as an eye exam, hearing test, and dental exam. Download a blank fillable dd form 2808 report of medical examination 2005 in pdf format just by clicking the download pdf button. Postdeployment health reassessment pdhra authority. The study that was conducted was based on data from service medical records of individuals who had served in the military, without regard to their enrollment in a hearing conservation program. Not acceptable class dd form 2808, oct 2005 02 may 07 dod exception to sf. If a student is over the age of 35, he or she must also hand carry an ekg and an age waiver. Army national guard and army reserve service obligations. Request for dd 214 or other military records nara sf 180. To update guidance to the enlisted to officer commissioning programs application administrative.
Dd form 28071 oct 2018 dod exception to sf 93 approved by icmr, august 3, 2000. Dd form 2808, report of medical examination, with instructions on how to complete. A dd 2808 form is used by the united states department of defense. Dd 2808 dd 28 203kb phu instructions for completing dd 28071, dd 2808, and dd 28. Dd form 2808, report of medical examination, october 2005.
This revised department of the army regulationo supersedes ar 591, 1 september 1994, io 2, 19 jun 96 and change 15 that was previously. Page 3 of form dd 2808 name and emplid at top of pagemust be completed. Current audiogram with signature on 2808 dental officers signature on 2808. The following forms are available on naval forms online. Dd form 28072, oct 2018 page 1 of 9 instructions for. Loss of memory or amnesia, or neurological symptoms 17. Medical forms commissioned corps management information. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Fill out, securely sign, print or email your 2808 form 2005 2019 instantly with signnow. Sign, fax and printable from pc, ipad, tablet or mobile. If dental examination not done by dental officer, explain in item 44 dod exception to sf approved by icmr. 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.
Information may be collected from you to provide and document your medical care. Dd form 26481, preseparation counseling checklist for. Dd form 2808, oct 2005 page 1 of 3 pages clinical evaluation check each item in appropriate column. Reports of audiometric testing in service medical records. 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. Defects and disease acceptable class dd form 2808 oct 2005 please explain. Sample rebuttal form pdf, 92kb tips and suggestions. Dd form 28071 report of medical history legal forms. Dd2808 644kb, report of medical examination privacy act statement pdf, 93kb right click and save link if you have issues viewing, 102005. Dd 2697 fill online, printable, fillable, blank pdffiller. Dd form 28072, medical prescreen of medical history. Print these forms and send the completed forms to dfas following the instructions provided.
If you are unable to find your form here, you may want to visit. Dd form 2808 oct 2005 fillable, afmc forms, manual lathe tooling, zimsec o level geography notes, investment advisor registration by state, free research papers with citations, afmc form 309, unified. Fill out the report of medical history online and print it out for free. Dd28071 report of medical history, dd2808 report of medical examination, phs6355 applicant dental exam form. If dental examination not done by acceptable dental officer, explain in item 44. Right click and save link if you have issues viewing 10 2005 phs7083 1,117kb behavioral health survey 042019 dd. Contact the department of defense forms manager for further details if this access is required. Create a free dd 2808 form in minutes with our professional document builder. Download fillable dd form 28071 in pdf the latest version applicable for 2020. The most secure digital platform to get legally binding, electronically signed documents in. Bringing quality young men and women into the army people who will complete their tours of duty and make a contribution to the nations defense is the objective of the u.