Report of Medical History Form for Military Service
This document is a Report of Medical History that individuals must fill out when seeking to join the Armed Forces. It collects essential medical information to assist the Department of Defense in evaluating the acceptability of applicants. This form is confidential and used for official purposes only.
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How do I fill this out?
To fill out this form, start by carefully reading the instructions provided. Make sure to answer all questions honestly and completely, marking each question as 'YES' or 'NO' where applicable. If you answer 'YES' to any question, be prepared to provide further explanations in the designated section.
How to fill out the Report of Medical History Form for Military Service?
1
Read through the entire form to understand the questions.
2
Complete the personal information section at the top.
3
Answer each medical history question with 'YES' or 'NO'.
4
Provide detailed explanations for any 'YES' answers.
5
Review your answers for accuracy before submitting the form.
Who needs the Report of Medical History Form for Military Service?
1
Individuals applying for military service who must disclose their medical history.
2
Recruiters who need to verify the health status of applicants.
3
Medical practitioners evaluating the fitness of military applicants.
4
Members of the Medical Evaluation Board reviewing current servicemen's health.
5
Individuals seeking to clarify their medical eligibility for military programs.
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What are the instructions for submitting this form?
To submit this form, ensure that it is completely filled out, then return it according to the following instructions. You may submit the form physically to your local recruiting office or designated medical examination site. For fax submissions, use the number provided on the form, and for any online submissions, follow the online procedure stated on the website where the form is being processed.
What are the important dates for this form in 2024 and 2025?
The Medical History Form does not have specific applicable dates, as it is required as part of ongoing medical evaluations for military service. However, keep in mind the potential changes in the OMB approval, which can affect form usage. Regular updates and revisions may happen, so it’s advisable to check for the most current version before submission.
What is the purpose of this form?
The primary purpose of this form is to collect comprehensive medical history from individuals applying for military service. It assists medical evaluators in determining the fitness of an applicant for military duty. This information is critical to ensure that all candidates are fully disclosed regarding their health status before enlistment.
Tell me about this form and its components and fields line-by-line.
- 1. Last Name, First Name, Middle Name (Suffix): The full name of the applicant.
- 2. Social Security Number: The applicant's unique identifier.
- 3. Today's Date: Date of filling out the form.
- 4. Home Address: Complete residential address of the applicant.
- 5. Home Telephone: Primary contact number of the applicant.
- 6. Examining Location and Address: Location where the medical examination will take place.
- 7. Current Medications: List of all medications being taken.
- 8. Allergies: Details of any known allergies.
- 9. Medical History Questions: Series of questions about past and current medical conditions.
- 10. Examiner's Summary: Space for the medical examiner to provide additional comments.
What happens if I fail to submit this form?
Failure to submit this form may lead to a delay in the application process or could result in the rejection of military service eligibility. It's crucial to complete and submit the form accurately to avoid complications.
- Delayed Processing: Incomplete forms can slow down the evaluation process.
- Potential Rejection: Not providing required information may lead to a denial of application.
- Inaccurate Medical Records: Failing to disclose medical history could result in incorrect assessments.
How do I know when to use this form?
- 1. Initial Enlistment: Complete this form when applying to join the military.
- 2. Medical Evaluations: Use during mandatory health evaluations.
- 3. Change of Status: Submit if there are significant health changes affecting service.
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What information do I need to fill out the form?
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