DA Form 4036 at a glance
What it is: DA Form 4036 (MAR 2007) is the Medical and Dental Preparation for Overseas Movement.
Where and when to file: Complete the medical and dental status portions, return the original and one copy to the MDP/PSC within 21 calendar days of the date shown in item 13E, and forward one copy to the address in item 6.
The MPD/PSC representative signs the Signature in 13C, the medical officer signs the Signature in 23C and the dental officer signs the Signature in 27C. Information is required on all soldiers being reassigned overseas to determine if they meet medical and dental standards for such assignment. Information is primarily obtained from review of records unless assignment is to be an isolated area which requires evaluation and personal interview. If family members are required to complete medical and dental evaluation and personal interview, but refuse to do so, they will not be permitted to accompany the soldier to the oversea assignment.
A filled-in DA Form 4036 example: a representative prepares a soldier for overseas movement
How to fill out DA Form 4036, box by box
TO, FROM, Name, SSN, Grade or Rank and PMOS or AOC
Enter the 1. TO and the 2. FROM.
Enter the Name (Last, Middle, First) in 3, the SSN in 4, the Grade or Rank in 5A and the PMOS or AOC in 5B.
Present and Projected Unit of Assignment, Projected Duty MOS or AOC and Anticipated Date of Loss
Enter the Present Unit of Assignment in 6 and the Projected Unit of Assignment (Include location/country) in 7.
Enter the Projected Duty MOS or AOC (9 Position Code) in 8 and the Anticipated Date of Loss in 9.
Items 10 and 11, the isolated area and the family members
Mark Yes or No in 10: is the member being assigned to an isolated area as defined by AR 40-501, para 5-13C?
If the answer to item 10 is "Yes" and the member is requesting family travel, all family members will be screened by the local medical treatment facility for special medical and functional needs; enter the names of all accompanying family members, otherwise enter N/A.
Special Medical or Dental Instructions and the Name of MPD/PSC Representative
List any other special medical or dental instructions contained in the assignment instructions in 12.
The MPD/PSC representative enters the Name of MPD/PSC Representative in 13A and the Title in B, signs the Signature in C, and enters the Grade in D and the Date (YYYYMMDD) in E.
Items 14 and 15, the profile and the medical fitness
Enter the Physical Profile Serial Code (PULHES) in 14A, the Physical Category Code in B and the Medical Records Reveal the following Assignment Limitations in C.
Mark Yes, No or Item N/A in 15A: does the member meet the medical fitness standards outlined in AR 40-501? If "no" explain briefly.
If the condition is temporary, enter the expected date the member will be eligible for assignment.
HIV screening, Expected Date of Delivery and hepatitis B vaccine
16A. Has member completed HIV screening? B. Date, time and location of appointment.
17A. Is the member pregnant? B. If "yes", enter the expected date of delivery.
18A. All active duty and reserve personnel of PCS assignment to Korea will be vaccinated with hepatitis B vaccine. Does the member require immunization? B. If "yes", indicate the date, time and location of appointment.
Items 19 to 21, remedial care, rehabilitation and limited facilities
19A. Does the member require remedial medical care?
20A. Is the member currently undergoing alcohol or drug abuse rehabilitation? B. If "yes", indicate the date the member entered the rehabilitation program.
21A. If item 10 is checked "yes", can the member be assigned to an area where medical facilities are limited or nonexistent?
Item 22, the medical records requirements
In 22, check those appropriate, as the medical records indicate the member requires: A Two pairs of spectacles, B. Protective mask spectacle insert, C. Two hearing aids and D. Medical warning tag, each with Missing, Has or Requires and the date, time and location of appointment, if needed.
Name of Medical Officer
The medical officer enters the Name of Medical Officer in 23A and the Title in B, signs the Signature in C, and enters the Grade in D and the Date (YYYYMMDD) in E.
Items 24 to 26, the dental status
Complete the dental status only if item 10 is checked "Yes" or if required by item 12.
24A. Is the member dentally qualified? B. If "no", briefly explain; if the condition is temporary, enter the expected date the member will be eligible for assignment.
25A. Does the member require remedial dental care? B. If "yes", indicate the date, time and location of the dental appointment.
26A. If item 10 is checked "yes", can the member be assigned to an area where dental facilities are limited or nonexistent?
Name of Dental Officer
The dental officer enters the Name of Dental Officer in 27A and the Title in B, signs the Signature in C, and enters the Grade in D and the Date (YYYYMMDD) in E.
More rules for DA Form 4036
For use of this form, see AR 600-8-11; the proponent agency is DCS, G-1.
Follow-up evaluation
Follow-up evaluation of medical status
Two B lines ask for a follow-up: 21B, after 21A (if item 10 is checked "yes", can the member be assigned to an area where medical facilities are limited or nonexistent?), and 26B, after 26A (if item 10 is checked "yes", can the member be assigned to an area where dental facilities are limited or nonexistent?). If "yes", the member (and family members, if applicable) must be scheduled for a follow-up evaluation of medical status within 30 calendar days of the anticipated date of loss (Item 9). Indicate the date, time and location of appointment(s).
Common questions about DA Form 4036
Is there a deadline?
Return the original and one copy to the MDP/PSC within 21 calendar days of the date shown in item 13E.
Where do I file it?
Forward one copy to the address in item 6 and return the original and one copy to the MDP/PSC within 21 calendar days of the date shown in item 13E.
Sources
[1] DA Form 4036 (MAR 2007), Medical and Dental Preparation for Overseas Movement, Department of the Army (the Official source link on this page).
