Da Form 7349 PDF Details

In the sphere of military health assessments and personnel readiness, the DA Form 7349, or the Initial Medical Review - Annual Medical Certificate, plays a pivotal role, established under the directives of AR 40-501 with the oversight of OTSG (Office of The Surgeon General). Its essence is captured by the requirement of the Privacy Act of 1974, emphasizing the voluntary, yet critical nature of the information it gathers to ensure individuals in service receive comprehensive care and are evaluated for medical readiness, without denying care for incomplete information. This form is meticulously designed to streamline the evaluation process, starting with the service member's acknowledgment of any medical or dental conditions, treatments, or hospitalizations since their last examination, extending to any medications taken that could affect their readiness status. The form also delves into the individual’s compensation history for health or physical reasons, ensuring a holistic view of the soldier’s health and capability. The process extends through multiple stages of review, from the initial assessment completed by the soldier, to detailed observations by a reviewing officer, and finally, a physician's evaluation including the determination of the soldier's medical readiness through the "PULHES" (Physical, Upper body, Lower body, Hearing, Eyes, and Psychiatric) Functional Capacity Scale. The DA Form 7349 culminates in directives or recommendations by an approving authority, thereby serving as a crucial instrument in maintaining operational readiness and optimal health among military personnel.

QuestionAnswer
Form NameDa Form 7349
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names00ES, da form 7349 fillable, false, da7349

Form Preview Example

INITIAL MEDICAL REVIEW - ANNUAL MEDICAL CERTIFICATE

For use of this form, see AR 40-501; the proponent agency is OTSG

DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority

Purpose

Section 133, Title 10, United States Code (10 USC 133).

The primary use of this information is to provide medical information of sufficient detail to ensure uniformity in medical evaluation. Used to evaluate soldiers in terms of medical conditions and physical defects which may require medical care or which may require a determination of medical readiness.

Routine Uses

Disclosure

None.

The requested information is voluntary because of the need to document all medical incidents in view of future rights and benefits. If the requested information is not furnished, comprehensive health care may not be possible, but CARE WILL NOT BE DENIED.

PART I -- COMPLETED BY SOLDIER

 

Please check the appropriate response column for each question below.

YES

NO

 

 

 

 

 

 

 

1.

Do you currently have any medical/dental problems?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Have you had any medical or dental problems since your last periodic physical examination?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.Have you been seen by or been treated by a dentist, physician, or other health care provider since your last periodic physical examination?

4. Have you been hospitalized or had surgery since your last periodic physical examination?

5.Are you currently taking medication, or have you taken prescription medication since your last examination?

6.Are you currently or have you in the past received a VA Disability, Workmen's Compensation, or other type of compensation for health or physical reason?

7.LIST ANY MEDICATIONS YOU ARE CURRENTLY TAKING

8. EXPLAIN ANY POSITIVE ANSWERS GIVEN ABOVE

I certify that the above information is true and correct to the best of my knowledge. I further understand that false statements made on this form may be cause for reassignment, discharge, or other disciplinary action.

9. DoD ID NUMBER

10. RANK/GRADE

11. MOS

12. DATE

 

 

 

 

13a. PRINTED/TYPED NAME

 

13b. SIGNATURE

 

 

 

 

 

DA FORM 7349, MAY 2014

PREVIOUS EDITIONS ARE OBSOLETE

Page 1 of 2

APD LC v1.00ES

 

 

PART II -- COMPLETED BY INITIAL REVIEWER

 

 

 

 

 

 

 

14.

INITIAL REVIEWER'S NOTES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

MEDICALLY

REQUIRES

 

 

16. SIGNATURE

 

 

 

17. DATE

 

READY

FURTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EVALUATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART III -- COMPLETED BY PHYSICIAN

 

 

 

 

 

 

 

18.

PHYSICIAN'S REVIEW NOTES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19.

MEDICALLY

NOT MEDICALLY

NOT MEDICALLY

20. Complete "PULHES" using the

P

U

L

H

E

S

 

 

 

 

 

 

 

 

 

READY

READY (USAR

READY (Army National

 

Physical Profile Functional

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

refer to para 9-10 &

Guard refer to MDRB)

 

Capacity Guide in Table 7-1,

 

 

 

 

 

 

 

 

 

9-11 AR 40-501)

 

 

 

 

AR 40-501.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21.

DA FORM 3349 IS ATTACHED

 

 

22. SIGNATURE

 

 

 

23. DATE

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART IV -- COMPLETED BY APPROVING AUTHORITY

 

 

 

 

 

 

 

24.

MISCELLANEOUS RECOMMENDATIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

SIGNATURE

 

 

 

 

 

 

 

 

26. DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

DA FORM 7349, MAY 2014 (BACK)

 

 

 

 

 

 

 

 

 

Page 2 of 2

APD LC v1.00ES

How to Edit Da Form 7349 Online for Free

Dealing with PDF files online is definitely very simple using our PDF tool. You can fill in 00ES here effortlessly. To keep our editor on the forefront of convenience, we aim to adopt user-oriented features and enhancements regularly. We are always grateful for any suggestions - help us with remolding PDF editing. It just takes several basic steps:

Step 1: Press the "Get Form" button at the top of this page to get into our PDF editor.

Step 2: This tool lets you modify your PDF document in various ways. Change it with customized text, adjust original content, and place in a signature - all when you need it!

This PDF requires specific information to be filled in, hence you need to take your time to enter exactly what is asked:

1. To begin with, while filling in the 00ES, beging with the part with the subsequent blank fields:

Filling in section 1 in 1974

2. After filling out the last section, go on to the subsequent step and fill in the necessary details in these blanks - DoD ID NUMBER, RANKGRADE, MOS, DATE, a PRINTEDTYPED NAME, b SIGNATURE, DA FORM MAY, PREVIOUS EDITIONS ARE OBSOLETE, Page of, and APD LC vES.

Ways to complete 1974 step 2

People who use this form frequently make errors when filling in Page of in this area. Don't forget to review whatever you type in here.

3. The following section will be focused on INITIAL REVIEWERS NOTES, MEDICALLY READY, REQUIRES FURTHER EVALUATION, SIGNATURE, DATE, PHYSICIANS REVIEW NOTES, and PART III COMPLETED BY PHYSICIAN - fill out every one of these fields.

1974 conclusion process explained (part 3)

4. To move ahead, this fourth step will require filling out a couple of form blanks. These include MEDICALLY READY, NOT MEDICALLY, READY USAR, refer to para, NOT MEDICALLY, Complete PULHES using the, P U, READY Army National, Guard refer to MDRB, Physical Profile Functional, DA FORM IS ATTACHED, SIGNATURE, DATE, YES, and MISCELLANEOUS RECOMMENDATIONS, which you'll find crucial to carrying on with this form.

P U, NOT MEDICALLY, and READY USAR inside 1974

Step 3: Prior to submitting this document, make sure that all blank fields have been filled in properly. When you think it's all good, press “Done." Create a 7-day free trial subscription with us and get direct access to 00ES - downloadable, emailable, and editable in your personal account. We don't share or sell any information that you type in while working with documents at our site.

Da Form 7349 isn’t the one you’re looking for?

Related Documents