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. Contact the department of defense forms manager for further details if. Dd form 2697, report of medical assessment, february 1995. Once completed you can sign your fillable form or send for signing. Fillable report of medical history dd28071 dd form 28071. Telephone number name telephone number name in regard to other assistance available, contact the command victimwitness liaison vwl, or the person identified below. Dd form 2870 fillable fill out printable pdf and word sample. Please return this instruction sheet with your dd form 28071, report of medical history, to. Department of defense dd form 2701, mar 2016 previous edition is obsolete. Dd form 28072, medical prescreen of medical history. Dd form 2807 2 fill out and sign printable pdf template. Physicianpractitioner may develop by interview any additional medical history deemed.
Turn them into templates for multiple use, incorporate fillable fields to collect recipients. Military physicians determine if an applicant can be accepted or should be disqualified on medical grounds with the help of it. Fillable dd form 28071 defense technical information. Nervous trouble of any sort anxiety or panic attacks e. I understand that falsification of information on the dd28071 report of medical history. Dd form 28071 is often used in dd 2807 forms, dd forms, u. My medical history is required to be on the dd28071.
Dd form 2795, sep 2012 previous edition is obsolete page 1 of 7 pages predeployment health assessment. Dd form 2792, family member medical summary, august 2014. Transform them into templates for numerous use, incorporate fillable fields to collect recipients. Sexually transmitted disease syphilis, gonorrhea, chlamydia, genital. Take advantage of a digital solution to create, edit and sign contracts in pdf or word format online. Dd74 dependency statement child born out of wedlock under age 21 dd448 military interdepartmental purchase request dd397 claim certification and voucher for death gratuity payment dd462 bond of person designated to act on behalf of. Dd form 28071 oct 2018 page 2 of 3 pages last name, first name, middle name suffix social security number b.
Take advantage of a digital solution to develop, edit and sign documents in pdf or word format online. This form is to be completed by each individual who requires medical processing in accordance with department of defense instruction dodi. 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 dod exception to sf 93 approved by icmr, august 3, 2000.
Submit an application between 90 and 180 days prior to separation or retirement. Department of defense, army forms, business, united states federal legal forms and united states legal forms. Fill out, securely sign, print or email your dd form 2807 2 print instantly with signnow. Va separation health assessment for service members. Fill out, securely sign, print or email your dd 2807 1 continuation form instantly with signnow.
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. The form must be forwarded by email, to each entity or person, thats required to fill out and digitally sign the form. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Make the most of a digital solution to develop, edit and sign contracts in pdf or word format on the web. Dd form 28071 report of medical history legal forms. Fill online, printable, fillable, blank report of medical history dd28071 dd form 28071, report of medical history, 20160516 draft form use fill to complete blank online jacksonville university pdf forms for free. Related content dd 2807 2 pdf fillable dd 28072, 20061106 draft reginfo. 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 28072, accessions medical prescreen report. Do the job from any gadget and share docs by email or fax. Dd 2807 1 fill out and sign printable pdf template signnow. Convert them into templates for multiple use, incorporate fillable fields to collect recipients. Pdf run dd 28071 20152017 fillable form dd 28071 20152017 dd 28071 is a department of defense form which is used for gathering medical information for applicants to military services.
Fill out the report of medical history online and print it out for free. Dd form 2808 is used by the meps medical staff to document the medical examination. Mark x all services being provided to the family member. As such, i would like to direct your attention to the principal purposes section of dd form 28071 which states the primary collection of this information is from individuals seeking to join the armed forces. 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. The information collected on this form is used to assist dod physicians in making determinations as to acceptability of applicants for. Dd form 28071, oct 2003 page 2 of 3 pages last name, first name, middle name suffix social security number b. The content you see here is paid for by the advertiser or content provider whose link you click on, and is recommended to you by revcontent. The purpose of dd 2808 is to record physical examination results to determine whether a student meets the standards established for the type of scheduled training. Dd form 2807 1 2001 fill online, printable, fillable. Loss of memory or amnesia, or neurological symptoms 17.
Dd form 28071 download fillable pdf or fill online report. To be completed by the administrator in consultation with the family. Dd form 28071, mar 2015 dod exception to sf 93 approved by icmr, august 3, 2000. Fillable form dd 28071 20152017 dd 28071 is a department of defense form which is used for gathering medical information for applicants to military services. Adverse reaction to serum, food, insect stings or medicine l.
Examiners summary and elaboration of all pertinent data physicianpractitioner shall comment on all positive answers in questions 10 29. Use va form 21526ez, application for disability compensation and. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly no software. Dod medical forms 2807 and 2808 used by recruiters meps. Department of defense active dutyreserve forces dental examination. This form has not been set up to work with a texttospeech reader. Start a free trial now to save yourself time and money. Dd form 28071, mar 2007 page 2 of 3 pages last name, first name, middle name suffix social security number b. Dd form 28071, report of medical history, october 2003.
Page 1 of 9 instructions for completing dd form 28072, accessions medical history report. Adobe reader or any alternative for windows or macos are required to access and complete fillable content. Download a blank fillable dd form 28071 defense technical information center in pdf format just by clicking the download pdf button. Laboratory tests may be required, as well as an eye exam, hearing test, and dental exam. Create a free dd 2808 form in minutes with our professional document builder. Dd form 28071, jul 2001 dod exception to sf 93 approved by icmr, august 3, 2000. Fill dd form 2807 1 2001, download blank or editable online. Get the job done from any gadget and share docs by email or fax. Its used by meps during the meps medical examination. Dd2808 report of medical examination instructions for international military students.
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