Examineeapplicantwill be used by some military facilities. 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. Use fill to complete blank online jacksonville university pdf forms for free. Dd form 28071, report of medical history, with instructions on how to complete the form. Please return this instruction sheet with your dd form 28071, report of medical history, to. Fillable report of medical history dd28071 dd form 28071. Military physicians determine if an applicant can be accepted or should be disqualified on medical grounds with the help of it. Sf 93 and dd form 28071, report of medical history. Dd form 2808 is used by the meps medical staff to document the medical examination. A dd form 28071 is a department of defense form is used for gathering medical information for applicants to military service. Navy, air force, army, marine corps, coast guard or our allies. Telephone number name telephone number name in regard to other assistance available, contact the. Report of formmedical history approved united states.
Fill out the report of medical history online and print it out for free. The form is used by military physicians to determine if an applicant can be accepted or should be disqualified on medical grounds. 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. General instructions for completing medical examination forms. Attach the completed report of medical history dd 28071 to this form. Marine special operations school nswso duty examination. Detailed guidance on the screening process is found in bumedinst 0. Dd form 28072, medical prescreen of medical history. Marine special operations school nswso duty examination instructions references. Dd form 28071 report of medical history legal forms. Fleet officer application checklist navy recruiting.
Dd74 dependency statement child born out of wedlock under age 21 dd448 military interdepartmental. Pdf, survivor benefit plan election change certificate dd form 28071. 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. You shall be required to submit a completed dd form 28071 upon check in to the command. Dd form 28071 is often used in dd 2807 forms, dd forms, 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 is warranted. This form sometimes confused with the da form 2807, military working dog. Dd form 28071, report of medical history, october 2003. This report of medical assessment is to be used by the medical services to provide a comprehensive medical assessment for active and reserve component service members separating or retiring from active duty. Dd form 2808, report of medical examination, with instructions on how to complete the form.
Download fillable dd form 28071 in pdf the latest version applicable for 2020. Receipt for prisoner completed by the correctional facility staff upon arrival of the prisoner 6. Dd form 28071 download fillable pdf or fill online report. Navy navmed p117, manual of the medical department, article 15, sections 32. Loss of memory or amnesia, or neurological symptoms 17. This form is to be completed by each individual who requires medical processing in accordance with army regulation 40501 chapter 2 standards, or department of defense directive 6. Dod medical forms 2807 and 2808 used by recruiters meps.
Department of defense dd form 2701, mar 2016 previous edition is obsolete. Dd form 1172 1 instructions generate a dd form 11722 for dependents in need of a new identification 1. Dd form 28071 oct 2018 page 2 of 3 pages last name, first name, middle name suffix social security number b. This form has not been set up to work with a texttospeech reader.
Instructions for completing dd28071 report of medical history items 1 through 5 on page 1 of the form must be completed including information on the top of. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Nervous trouble of any sort anxiety or panic attacks e. Dd form 214 separation dd form 280828071 hiv results within last 12 months, dd form 2697 copy of last 3 evaluations prims printout relocation flexibility if you relocate, the navy reserve has flexibility that may allow for authorized absences of. Nrotc college program minimum eligibility requirements. Download fillable dd form 28071 in pdf the latest version applicable for.
Before the exam, complete the dd form 28071, report of medical history. Dd form 28071 download fillable pdf or fill online report of. Nrotc college program minimum eligibility requirements list for navy options page 1 of 2. Contact the department of defense forms manager for further details if. 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. Fill online, printable, fillable, blank report of medical history dd28071 dd form 28071, report of medical history, 20160516 draft form. Tricare online patient portal service separationretirement.
Va separation health assessment veterans benefits administration. The dod dd form 28071 report of medical history, referred to in paragraph 3. Documents any medical concerns identified during your military career. Its used by meps during the meps medical examination. Va separation health assessment for service members. Once completed you can sign your fillable form or send for signing. Page 1 of 9 instructions for completing dd form 28072, accessions medical history report. Dd form 28071, report of medical history, is available. For military personnel, it is used to designate beneficiaries for. Adverse reaction to serum, food, insect stings or medicine l.
You are here home legal forms department of defense dd forms dd28 department of defense active dutyreserve forces dental examination. Dd form 28071, jul 2001 dod exception to sf 93 approved by icmr, august 3, 2000. Report of formmedical history approved united states navy. Dd form 28071, oct 2003 page 3 of 3 pages last name, first name, middle name suffix social security number 30. Department of defense, army forms, business, united states federal legal forms and united states legal forms. Create a free dd 2808 form in minutes with our professional document builder. Laboratory tests may be required, as well as an eye exam, hearing test, and dental exam. Department of defense active dutyreserve forces dental examination. Pdf, reserve component survivor benefit plan rcsbp election certificate dd form 26566. Form 28071, jul probiem 2001 page 1 of 3 pages dud exception to sf 93 approved by icmr, august 3, 2000. This form is used by military personnel and department of defense civilian and contractor personnel, collectively referred to as civilians, when applicable. Dd form 28071, mar 2015 page 3 of 3 pages last name, first name, middle name suffix social security number 30.
The assessment will cover, as a minimum, the period since the. Page 2 of form dd2808 name and emplid at top of page must be completed. 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. This form is to be completed by each individual who requires medical processing in accordance with department of defense instruction dodi.
Public health service\ngeneral instructions for completing medical examination forms dd28071 report of medical history and dd2808 report of medical. Completed forms are covered by recruiting, medical evaluation board, and official military personnel file sorns. Every item marked yes must be fully explained in item 29 below. Nswso exam checklist sample dd form 28071 sample dd form 2808 nswso template dd form 2808. Dd form 26 97, report of medical assessment, february 1995.
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