Army Functional Capacity Form 507 – Fill Out and Use This PDF

The Army Functional Capacity Certificate Form 507 (FCC507) is a critical document designed to evaluate a service member's physical capabilities regarding specific military duties and potential limitations due to medical conditions. It requires the service member to answer a series of questions about their medical condition and its impact on tasks such as walking, carrying gear, and overall functional capacity. This form plays a pivotal role in determining the appropriate duties a service member can perform, which may lead to further evaluations or adjustments in their service profile. For detailed guidance on how to fill out the form correctly, click the button below.

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Army Functional Capacity Form 507 PDF Details

In the rigorous environment of military service, the health and functional capacity of service members are of paramount importance. Recognizing this, the Army Functional Capacity Certificate Form 507 (FCC507) serves as a critical tool in evaluating and documenting a soldier's physical capabilities and limitations. Required to be completed by the service member, this comprehensive form prompts individuals to disclose any medical conditions that might influence their ability to perform various physical tasks, ranging from walking specific distances in combat boots and field gear, to lifting weights, and enduring prolonged periods of standing. Moreover, the form extends to include inquiries about a soldier's capacity to carry and fire weapons, wear protective gear, execute combat movements, and partake in standard aerobic and strength training activities. It also delves into medical conditions that could affect deployment readiness, touching on mental health and chronic conditions like asthma. Notably, the form emphasizes the necessity of a physician's review and concurrence with the service member’s self-assessment, thereby ensuring an accurate and authoritative evaluation of the soldier's functional capacity. With sections designed to capture explicit details about any medical conditions, medications taken, and existing medical profiles, the FCC507 stands as a crucial step in safeguarding the health and operational readiness of Army personnel.

Question	Answer
Form Name	Army Functional Capacity Form 507
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	what are syntactic errors, standard form 507, capacity certificate form, army form 507

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Functional Capacity Certificate Form 507 (FCC507)

NOTE: TO BE COMPLETED BY SERVICE MEMBER: PLEASE READ QUESTIONS CAREFULLY:

Answer All Questions by placing an X in the appropriate block. This information constitutes an Official Statement. Certain medical conditions and/or limitations may indicate need for further evaluation and/or additional information and/or change in Profile and/or referral to Medical Evaluation Board (MEB) and/or Military Occupational Specialty Medical Board (MMRB). Bracketed Numbers ([1], [2], [3]) may be reflected in your Physical Profile.

1.	Soldiers may be required to walk 12 miles in Combat Boots. Do you have a Medical Condition that prevents you
	from doing so? What is the Medical Condition?	θ YES [ ]	θ NO [1]
	If YES, can you walk 4 miles in Combat Boots?	θ YES [2]	θ NO [3]
2.	Soldiers may be required to walk 12 miles with Field Gear (BDU, Helmet, LBE, Canteens, Protective Mask, Weapon,
	Without Rucksack). Do you have a Medical Condition that prevents you from doing so?	θ YES [ ]	θ NO [1]
	What is the Medical Condition?
	If YES, can you walk 4 miles with Field Gear?	θ YES [2]	θ NO [3]
3.	Soldiers may be required to walk 6 miles with Field Gear and 40 lb. Ruck Sack. Do you have a Medical
	Condition that prevents you from doing so? What is the Medical Condition?	θ YES [ ]	θ NO [1]
	If YES, can you walk ¼ mile with Field Gear and Ruck Sack?	θ YES [2]	θ NO [3]
4.	Soldiers may be required to lift and carry 40 lbs. (2 cases of canned soda) a distance of 100 feet. Do you have a
	Medical Condition that prevents you from doing so? What is the Medical Condition?	θ YES [ ]	θ NO [1]
	If YES, can you lift and carry 35 lbs. (17” computer monitor) 100 feet?	θ YES [2]	θ NO [3]
5. Do you have a Medical Condition that prevents you from being on your feet continuously for 4 hours?		θ YES [ ]	θ NO [1]
	What is the Medical Condition?
	If YES, can you remain on your feet for 1 hour?	θ YES [2]	θ NO [3]
6.	Please complete the following:
	How far can you walk in Boots? ________with Field Gear? ________with Field Gear and Rucksack? ________
	How much and how far can you lift and carry? ________lbs. ________feet
	How long can you remain on your feet? Hours: ________ or Minutes: ________
7. Do you have a Medical Condition that prevents you from carrying and firing individual assigned Weapon?		θ YES [3]	θ NO [1]
	If YES, what is the Medical Condition?
8. Do you have a Medical Condition that prevents you from moving with a Fighting Load (48 lbs) 2 miles?		θ YES [3]	θ NO [1]
	(Includes: Helmet, Uniform, Boots, Load Bearing Equipment (LBE), Weapon, Pack, Protective Mask, etc.)
	If YES, what is the Medical Condition?
9. Do you have a Medical Condition that prevents you from wearing a Protective Mask?		θ YES [3]	θ NO [1]
	If YES, what is the Medical Condition?
10. Do you have a Medical Condition that prevents you from wearing All Chemical Defense Equipment?		θ YES [3]	θ NO [1]
	If YES, what is the Medical Condition?
11. Do you have a Medical Condition that prevents you from constructing an Individual Fighting Position		θ YES [3]	θ NO [1]
	(Dig; Lift & Carry Sandbags)?
	If YES, what is the Medical Condition?
12. Do you have a Medical Condition that prevents you from doing 3-5 second Rushes under direct and indirect fire?		θ YES [3]	θ NO [1]
	If YES, what is the Medical Condition?
13. Do you have any Medical Condition that might prevent Deployment?		θ YES [3]	θ NO [1]
	If YES, what is the Medical Condition?
14. Do you have a Medical Condition that prevents you from performing the Army Physical Fitness Test (APFT)		θ YES [2]	θ NO [1]
	2 Mile Run?
	If YES, what is the Medical Condition?
	If you cannot perform APFT 2 Mile Run, you must perform an Aerobic Alternate APFT:
	Walk and/or Bicycle and/or Swim. Indicate the Aerobic Alternate APFT Events you can perform.
	θ WALK [2] θ BICYCLE [2] θ SWIM [2]	θ [3]
	I cannot perform the APFT 2 Mile Run or any Aerobic Alternate APFT Events (Walk or Bicycle or Swim).	θ [3]

15. Do you have a Medical Condition that prevents you from doing APFT Push Ups?		θ YES [2]	θ NO [1]
	If YES, what is the Medical Condition?
16. Do you have a Medical Condition that prevents you from doing APFT Sit Ups?		θ YES [2]	θ NO [1]
	If YES, what is the Medical Condition?
17. Do you have a Medical Condition that prevents you from doing Standard Aerobic Conditioning Activities?		θ YES [2]	θ NO [1]
	If YES, what is the Medical Condition?
	Indicate the Activity you CANNOT perform: θ Running θ Walking θ Biking θ Swimming
18.	Do you have a Medical Condition that prevents you from doing Upper or Lower Body Weight Training?	θ YES [2]	θ NO [1]

Name: ________________________________________ Address: ______________________________

SSN: _________________Unit:______________________E-Mail: ______________________________________

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	If YES, what is the Medical Condition? __________________________________________________________
	Indicate the Activity you CANNOT perform: θ Upper Body				θ Lower Body
19.	Have you been treated for Any Mental Health Condition in the Past 5 Years?					θ YES [?]	θ NO [1]
	If YES, what is the Mental Health Condition?
20.	Have you been Diagnosed with Asthma?		If YES, Answer All Questions in # 20; If No: Go to # 21			θ YES [?]	θ NO [1]
	a. Have you been Admitted to a Hospital, Visited an Emergency Department or Lost Time From Work due to
	Asthma and/or Asthma Related Condition(s)? θ YES				θ NO
	If YES, how many Admissions? _____ Emergency Department Visits? _____ Lost Work Days? _____
	b. Have you taken Oral and/or Inhaler Steroid Medications for your Asthma in past 12 mos? θ YES θ NO
	If YES: How many times? ______ x daily; ______ x weekly; ______x monthly
	c. If you can use your inhaler beforehand, would your Asthma still prevent you from taking and passing the
	APFT 2 Mile Run Event?	θ YES θ NO
	d. Does your Asthma prevent you from Wearing a Protective Mask? θ YES θ NO
21.	Do you have a Medical Condition that requires any Breathing Assist Device and/or Supplemental Oxygen?					θ YES [?]	θ NO [1]
	If YES, what is the Medical Condition?
22.	Do you take any Medication to Control your Blood Sugar?					θ YES [?]	θ NO [1]
	If YES, indicate type: θ Pills	θ Shots	List Medication Names:
23.	Do you currently take Any Prescription and/or Non Prescription Medications?					θ YES	θ NO
	If YES, Specify Medications and Medical Conditions:
24.	Do you currently have a Permanent Profile?			If YES, what is the Date of Issue (month/day/year)?		θ YES	θ NO
	What is the Medical Condition?
	What are the Recommended Limitations?
25.	Do you currently have a Temporary Profile?			If YES, what is the Date of Expiration (month/day/year)?		θ YES	θ NO
	What is the Medical Condition?
	What are the Recommended Limitations?

Date: (month/day/year):

Service Member’s Signature:

NOTE: THE FOLLOWING SECTION MUST BE COMPLETED AND SIGNED BY THE EXAMINING PHYSICIAN. Physician, Please Read The Following:

Your Evaluation of this Soldier’s Functional Capacity is important. Please review the Soldier’s responses carefully especially those involving “YES” answers. Complete 3 Items (below), provide your Full Name, Credentials, Contact Information and Certify Your Opinion with Your Full Signature.

NOTE: ALL INFORMATION MUST BE LEGIBLE AND READABLE INCLUDING SIGNATURE:

1.Physician’s Findings: List All Current Diagnoses with Respective Current Physical Limitations. If “No Current Physical Limitations”, indicate “None.”

____________________________________________________________________________________________________________

2.Physician’s Statement: I have reviewed this Service Member’s Functional Capacity Certificate (FCC507) and [Circle One: CONCUR / DO-NOT-CONCUR with Service Member’s Self Assessment.” Explain Any DO-NOT-CONCUR:

____________________________________________________________________________________________________________

3.Limitations are θ Permanent (or) θ Temporary. If Temporary, Expected Duration of Limitations is ___________Days.

Physician’s Full Name (Print or Type): ____________________________________ Date of Evaluation: ____________________

Physician’s Full Signature: ___________________________________________Physician’s Medical Degree (MD, DO): _______

Physician’s Medical Specialty or Specialties: _____________________________________________________________________

Telephone Area Code & Number: ____________________________Fax Area Code & Number: __________________________

Name: ________________________________________ Address: ______________________________

SSN: _________________Unit:______________________E-Mail: ______________________________________

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How to Edit Army Functional Capacity Form 507 Online for Free

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It's straightforward to complete the pdf following this practical tutorial! Here's what you want to do:

1. The military form 507 will require certain information to be inserted. Ensure the subsequent blank fields are filled out:

fcc 507 writing process outlined (stage 1)

2. Right after filling out the previous step, head on to the next part and complete all required details in all these blanks - Do you have a Medical Condition, Includes Helmet Uniform Boots Load, If YES what is the Medical, Do you have a Medical Condition, If YES what is the Medical, Do you have a Medical Condition, If YES what is the Medical, Do you have a Medical Condition, Dig Lift Carry Sandbags, YES NO YES NO , YES NO YES NO , YES NO , If YES what is the Medical, Do you have any Medical Condition, and If YES what is the Medical.

fcc 507 completion process described (stage 2)

3. The following portion is focused on If YES what is the Medical, Do you have a Medical Condition, If YES what is the Medical, Do you have a Medical Condition, If YES what is the Medical, YES NO YES NO YES NO , YES NO , Name Address , SSN UnitEMail , and Page of - fill out these empty form fields.

A lot of people often make mistakes when completing YES NO in this section. You should reread everything you enter right here.

4. Filling in If YES what is the Medical, If YES what is the Mental Health, Have you been Diagnosed with, a Have you been Admitted to a, c If you can use your inhaler, If YES what is the Medical, Do you take any Medication to, YES NO YES NO , YES NO YES NO YES NO, and If YES Specify Medications and is paramount in the fourth step - ensure that you spend some time and be attentive with every single blank area!

fcc 507 writing process explained (step 4)

5. To finish your form, the final section includes some additional fields. Filling in What are the Recommended, Do you currently have a Temporary, What is the Medical Condition, What are the Recommended, Service Members Signature, YES NO, NOTE THE FOLLOWING SECTION MUST BE, and Physicians Findings List All will finalize the process and you'll be done in the blink of an eye!

Step 3: Right after you have looked once again at the information you given, just click "Done" to conclude your document creation. Join us right now and immediately use military form 507, available for download. Every change you make is conveniently kept , which enables you to modify the file at a later stage if needed. We do not sell or share the details that you type in while filling out forms at our website.

Army Functional Capacity Form 507 – Fill Out and Use This PDF

Army Functional Capacity Form 507 PDF Details

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