Standards of medical fitness center for deployment psychology. If the form number does not have a hyperlink, the form is not available electronically. Google recommends visiting our text version of this document. Download a blank fillable dd form 28071 defense technical information center in pdf format just by clicking the download pdf button. Physicianpractitioner may develop by interview any additional medical history deemed. Dd form 28071 is often used in dd 2807 forms, dd forms, u. Fill out the report of medical history online and print it out for free. Dod forms management washington headquarters services. Tumor growth cyst or cancer dod exception to sf 93 approved by icmr august 3 2000.
The form is designed to assist recruiters in the medical prescreening of applicants. A dd form 28071 is a department of defense form is used for gathering medical information for applicants to military service. Dd form 2807 1 oct 2018 page 2 of 3 pages last name, first name, middle name suffix social security number b. The dd form 28071 is available on the department of defense documentation website or. Every item marked yes must be fully explained in item 29 below. Dd form 28071 download fillable pdf or fill online report of. Sexually transmitted disease syphilis, gonorrhea, chlamydia, genital. Dd form 28071, report of medical history is a form primarily used by and within the department of defense dod to obtain medical information on individuals wishing to join the united states armed forces this form sometimes confused with the da form 2807, military working dog training and utilization record, or incorrectly called the da form 2807 was last revised in march 2015. Va separation health assessment for service members. Applicants to jrcostep instructions for completion of dd form 28071. General instructions for completing medical examination forms. This form is not an authorization or consent to use or disclose your health information. Dod exception to sf 88 approved by gsaoirm 488 dodmerb use only systolic diastolic right left 500 2000 3000 4000 6000 8.
Dd form 28072, medical prescreen of medical history report. Current dd28071 report of medical history no older than one year will be required for assimilation, permanent promotion, and long term training. I understand that the falsification or other nondisclosure of material medical information may result in the immediate close out of my application or my separation from active duty without benefits at any time during my career. Dd form 28071, mar 2007 page 2 of 3 pages last name, first name, middle name suffix social security number b. Every item marked have you ever had or do you now have. Dd form 28072, accessions medical prescreen report, march. W4 employee withholding allowance certificate pdf fillin warrior forge forms and documents. If you are unable to find your form here, you may want to visit. Loss of memory or amnesia, or neurological symptoms 17.
Last name first name middle initial suffix social security number last 4 section ii medical history continued. Completed forms are covered by recruiting, medical evaluation board, and official military personnel file sorns. Adverse reaction to serum, food, insect stings or medicine l. Dd form 2807 1, oct 2003 dod exception to sf 93 approved by icmr, august 3, 2000. 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 following forms are available on naval forms online. Dd form 28071, aug 2011 page 2 of 3 pages last name, first name, middle name suffix social security number b. Sf 93 and dd form 2807 1, report of medical history. To obtain hard copies of current forms not available in electronic format, please contact your own military service or dod component forms management officer.
All yes items must be fully explained in section iii. Report interim changes in medical history on dd form 28071 if these changes were not. Mecep ground aviation request commissioning package pdf. Before the exam, complete the dd form 28071, report of medical history. Military physicians determine if an applicant can be accepted or should be disqualified on medical grounds with the help of it. Dept of justice employment eligibility verification. Dd form 28071, report of medical history, october 2003. A dd form 2807 1 is a department of defense form which is used to gather medical information for applicants who need to accept military service. To download a document, rightclick on the link and select save target as. A dd form 2807 1 is a department of defense form is used for gathering medical information for applicants to military service.
This form should be completed by the dtf or civilian provider and will be used to assist the services in documenting member dental health. Dd form 2808 is used by the meps medical staff to document the medical examination. Dod medical forms 2807 and 2808 used by recruiters meps. Publications form records search to search for a pubform by its number, put in the acronym examples of acronyms. The dd form 2807 1 is available on the department of defense documentation website or. Application forms should be returned to dvc a r e moi university or p. Dod exception to sf 93 approved by icmr, august 3, 2000. 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 2807 1 report of medical history, to naval diving and salvage training center or navy special warfare. Sglv 8286 soldiers group life insurance form pdf fillin. Please return this instruction sheet with your dd form 28071, report of medical history, to. Dd form 28071 oct 2018 page 2 of 3 pages last name, first name, middle name suffix social security number b. Adobe reader or any alternative for windows or macos are required to access and complete fillable content.
Dd form 2807 1, oct 2003 page 2 of 3 pages last name, first name, middle name suffix social security number b. Reproduction of dd form 2808 and dd form 28071 815, page 17. The dd forms 2807 1, 2807 2, 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. Examination with two new forms, dd form 28071 report of medical history and dd form 2808 report of medical examination chap 8 and table 81. 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. Examiners summary and elaboration of all pertinent data physicianpractitioner shall comment on all positive answers in questions 10 29. Application request to add andor remove dependents fillable file type. Address information if left blank will delay processing b. Va separation health assessment for service members factsheet. Applicants to jrcostep instructions for completion of dd form 2807 1. Its used by meps during the meps medical examination.
Dd form 2492, dodmerb report of medical history, march 2008 author. Dd forms 25002999 updated 02192020 form availability. Dd form 28071, mar 2015 dod exception to sf 93 approved by icmr, august 3, 2000. Dd form 28071, oct 2003 page 3 of 3 pages last name, first name, middle name suffix social security number 30. Dd form 28071, oct 2003 page 2 of 3 pages last name, first name, middle name suffix social security number b. 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. The form is used by military physicians to determine if an applicant can be accepted or should be disqualified on medical grounds.
Report of medical moi university online application comment. Learn how to fill the dd 51 2 form military travel voucher duration. Request for dd 214 or other military records nara sf 180. Yes social security number must be fully explained in item 29 below. Below is a list of the most current united states army cadet command forms, checklists, policies, pamphlets, sops and regulations. Dd form 28 active dutyreserve forces dental examination the government requires all active duty and reserve members receive an annual dental examination. 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. Nervous trouble of any sort anxiety or panic attacks e. Department of defense, army forms, business, united states federal legal forms and united states legal forms. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Dd form 28072, medical prescreen of medical history. Medical screening for diving duty, eod and buds applicants.