What Is DA Form 2173?
DA Form 2173, the Statement of Medical Examination and Duty Status, is an official Army document used when a soldier is injured, falls ill, or develops a medical condition during service. Two parties complete the form: attending physicians fill out the medical examination sections, and unit commanders record the duty status at the time of injury. Together, these sections establish whether the injury or illness occurred in the line of duty, which directly affects a soldier's entitlement to Army medical care, disability pay, and other benefits.
When Is DA Form 2173 Required?
A DA Form 2173 is required for any injury, illness, or medical condition that needs treatment during active duty, Reserve, or National Guard service. Common situations include training accidents, on-duty vehicle incidents, and occupational illnesses. The form is typically initiated within 24 hours of treatment and must be completed before a Medical Evaluation Board proceeding can begin. AR 600-8-4 sets the deadlines and documentation standards that this form must satisfy.
Key Sections of DA Form 2173
The form has three primary sections that must all be completed accurately:
- Section I covers patient identification, including name, Social Security Number, rank, and unit assignment.
- Section II is completed by the unit commander and records whether the soldier was present for duty, on leave, on pass, or absent without authority at the time of injury.
- Section III is completed by the attending physician and covers diagnosis, nature and extent of the injury or disease, and an assessment of whether the condition may result in a claim against the government.
How to Fill Out DA Form 2173 Step by Step
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Step 1: Open the PDF editor by clicking the "Get Form" button at the top of this page.
Step 2: Once the editor loads, the document will be ready to complete. You can fill in blank fields, add custom text, edit existing text, insert images, sign the document, and more.
This form requires specific information, so take care when completing the following fields:
1. Fill out DA Form 2173 accurately, paying close attention to these fields:
2. Next, complete all of these fields: DATE, TYPED OR PRINTED NAME OF, SIGNATURE, SECTION II TO BE COMPLETED BY, DUTY STATION, PRESENT FOR DUTY, ABSENT WITHOUT AUTHORITY, ABSENT WITH AUTHORITY, ON PASS, ON LEAVE, HOUR AND DATE OF ABSENCE FROM, TO, ABSENCE WITHOUT AUTHORITY, YES, and INDIVIDUAL WAS ON. Double-check every entry before continuing.
A common error is entering incorrect information in the YES field. Review your entry here carefully.
3. In this section, complete TYPED NAME AND GRADE OF UNIT, DA FORM OCT, REPLACES DA FORM JUN WHICH IS, and APD PE vES with the highest accuracy.
Step 3: Before finishing, confirm that all fields are correctly filled in. When done, click "Done." Start a 7-day free trial to access DA Form 2173 and save all changes to your personal account. FormsPal keeps all personal information secure and confidential.
Related Army and Military Forms
When completing a line-of-duty process, you may also need these related forms:
- DA Form 2823 – Sworn Statement, used to collect witness accounts of an incident.
- DA Form 31 – Request and Authority for Leave, needed when absence status is relevant to the injury.
- SF 513 – Medical Record Consultation Sheet, used alongside DA Form 2173 for specialist referrals.
- DA Form 3947 – Medical Evaluation Board Proceedings, which typically follows a completed DA Form 2173.
- DA Form 2171 – Request for Accession or Evaluation, another form in the military medical processing pipeline.
Frequently Asked Questions
Who completes DA Form 2173?
The form requires two parties. The attending physician or hospital patient administrator completes the medical examination portion (Section III). The unit commander or unit adviser completes the duty status portion (Section II). Both signatures are required for the form to be valid.
What happens after DA Form 2173 is submitted?
A line-of-duty investigating officer reviews the completed form. The determination of "in line of duty" or "not in line of duty" affects eligibility for military medical benefits and potential disability ratings. If the condition appears permanent, the soldier may be referred to a Medical Evaluation Board proceeding.
Is DA Form 2173 the same as DD Form 2173?
No. DD Form 2173 is not an active Department of Defense form. DA Form 2173 is a Department of the Army document. References you may encounter to "DD Form 2173" typically refer to this Army form.
What is the difference between DA Form 2173 and DA Form 2173-A?
DA Form 2173-A is a continuation sheet used when additional space is needed to document a complex medical history or multiple injuries. Both forms are submitted together as a single package.