To submit the Report of Medical History form, follow the instructions provided on the last page of the document. You may submit it via email to the specified DoD address, or physically hand it over to the designated military office. Ensure that the form is completed accurately, as submissions that contain errors may lead to processing delays.

The OMB approval for this form expires on October 31, 2024. Ensure to submit a valid form before this date to avoid complications. Keep an eye on updates or changes in guidelines from the Department of Defense for the year 2025.

The primary purpose of the Report of Medical History form is to collect essential health information from individuals seeking to join the Armed Forces. This data assists DoD physicians in determining an applicant's medical suitability for military service. The form also helps in identifying potential disqualifying medical conditions based on the individual's health history.

• 1. Last Name, First Name, Middle Name (Suffix): Full legal name of the applicant.
• 2. Social Security No.: Applicant's Social Security Number for identification.
• 3. DoD ID No.: Department of Defense Identification Number, if applicable.
• 4. Home Address: Complete home address including street, apartment number, city, state, and ZIP code.
• 5. Examination Location and Address: Location where the medical examination will occur.
• 6. Home Telephone: Primary telephone number for contact.
• 7. Email Address: Email for communication regarding the application process.
• 8. Service: Branch of military service the applicant is seeking to join.
• 9. Purpose of Examination: Reason for the medical examination (e.g., enlistment, separation, etc.).
• 10. Current Medications: List of medications currently being taken by the applicant.
• 11. Allergies: List of known allergies including reactions.
• 12. Medical History Questions: Series of questions regarding past and present medical conditions.
• 13. Examiners Summary: Summary section completed by the examining physician.

Failing to submit the Report of Medical History could result in significant delays in the processing of your application to join the Armed Forces. In some cases, it may even lead to the rejection of your application due to incomplete medical history disclosure.

• Application Delay: Submission delays can push back your enlistment timeline.
• Possible Rejection: Inadequate medical information may lead to application rejection.
• Non-Deployable Status: Military members failing to provide necessary health data may face deployment issues.

• 1. Enlistment Applications: Required for individuals seeking to join any branch of the military.
• 2. Routine Medical Evaluations: Utilized for the assessment of current military members.
• 3. Medical Board Reviews: Necessary for evaluations regarding medical fitness for service.
• 4. Rejoining the Military: Required if previously discharged and seeking re-enlistment.
• 5. Veteran Program Applications: Some programs may require additional medical history from veterans.