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. Dd 2807 1 fill out and sign printable pdf template signnow. Download military body fat measurement chart for free. Adverse reaction to serum, food, insect stings or medicine l. Dd form 28071 report of medical history legal forms.
Dd form 28071 oct 2018 page 3 of 3 pages last name, first name, middle name suffix social security number 30. Convert them into templates for multiple use, incorporate fillable. I went in for my separation physical today and was turned away and told to redo my dd form 28071 correctly. Loss of memory or amnesia, or neurological symptoms 17.
This form is used to collect information on your physical and mental health status before a deployment. Fillable report of medical history dd28071 dd form 28071. Dod forms management washington headquarters services. The most secure digital platform to get legally binding, electronically signed. Tricare reserve select you may choose to end your coverage at any time. Its used by meps during the meps medical examination. Pdf, reserve component survivor benefit plan rcsbp election certificate dd form 26566. Learn vocabulary, terms, and more with flashcards, games, and other study tools. On the form, it states that i should circle yes or no if i have ever had or do you now. Please return this instruction sheet with your dd form 28071, report of medical history, to. Dod medical forms 2807 and 2808 used by recruiters meps.
Dd form 28071 download fillable pdf or fill online report. A dd form 28071 is a department of defense form is used for gathering medical information for applicants to military service. Ensure all yes answers on dd form 28071 are explained by the physician in block 29. The dd form 28071 is available on the department of defense documentation website or. Va separation health assessment for service members. Dd form 28071, mar 2015 page 2 of 3 pages last name, first name, middle name suffix social security number b. Fill out, securely sign, print or email your dd 2807 1 continuation form instantly with signnow. Sf 93 and dd form 28071, report of medical history. There are many ways to let dd form 2807 1 44205 dd 2807 1 pdf fillable send the filled out data and some other meta stuff to your server. Instructions for completing dd28071 report of medical history items 1 through 5 on page 1 of the form. Contact the department of defense forms manager for further details if this. Pdf, survivor benefit plan election change certificate dd form 28071. Dd form 28072, medical prescreen of medical history. 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, aug 2000 page 2 of 3 pages last name, first name, middle name suffix social security number b. The form is used by military physicians to determine if an. Marine corps recruiting command marine officer officer. The warrant officer wo program is designed to provide the marine corps with technical specialists who perform duties that require extensive knowledge of a. 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. Current dd28071 report of medical history no older than one year will be required for assimilation, permanent promotion, and long term training. Learn how to fill the dd 51 2 form military travel voucher duration. The data gathered on this form helps the dod physicians determine the physical fitness of the applicants and verifies any disqualifying conditions during the prescreening process. 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. This version of the adobe acrobat is not compatible with the apd website. Army publishing directorate army publishing directorate. Report of medical history dd28071 dd form 28071, report of medical. Military physicians determine if an applicant can be accepted or should be disqualified on medical grounds with the help of it. Fill out the report of medical history online and print it out for free.
Da form 28071 pdf dod has replaced the use of the sf 93 with the dd form and dd form is used by recruiters to prescreen applicants. Current dd 28071 report of medical history no older than one year will be required for assimilation, permanent promotion, and long term training. Examiners summary and elaboration of all pertinent data physicianpractitioner shall comment on all positive answers in questions 10 29. Fill out, securely sign, print or email your dd form 2807 2 print instantly with signnow. Download a blank fillable dd form 28071 defense technical information center in pdf format just by clicking the download pdf button. Download fillable dd form 28071 in pdf the latest version applicable for 2020. Dd form 28071 defense technical information center.
Before the exam, complete the dd form 28071, report of medical history. The form is designed to assist recruiters in the medical prescreening of applicants. I understand that the falsification or other nondisclosure of material medical. Dd form 2697, report of medical assessment, february 1995. An uptodate fillable dd form 28071 is available for download and electronic filing below on through the executive services directorate website. Dd74 dependency statement child born out of wedlock under age 21 dd448 military interdepartmental purchase request. Nervous trouble of any sort anxiety or panic attacks e. Reap the benefits of a digital solution to create, edit and sign contracts in pdf or word format on the web. As such, i would like to direct your attention to the principal purposes section of dd form 28071 which states the primary. Dd form 2807 2 fill out and sign printable pdf template.