What Is DA Form 7574-1?
DA Form 7574-1 is the Military Physician's Statement of Soldier's Incapacitation/Fitness for Duty. It applies to Reserve Component Soldiers in the U.S. Army. A military physician completes the form after evaluating the soldier's health status. The form documents whether the soldier can perform assigned military and civilian duties. It also supports incapacitation pay claims under DA PAM 135-381.
Who Is Authorized to Complete This Form?
Only a U.S. government or military physician may certify DA Form 7574-1. The physician evaluates the soldier and documents the findings directly. This includes the diagnosis, prognosis, and any duty restrictions. Civilian physicians are not authorized signatories for this form. The physician's certification determines the soldier's duty status and pay eligibility.
How to Fill Out DA Form 7574-1 Step by Step
- Section 1: Soldier Identification. Enter the soldier's full name, rank, and Social Security Number. Add the unit of assignment and confirm Reserve Component status.
- Section 2: Incapacitation/Fitness Verification. The physician marks the soldier as incapacitated or fit for duty. Enter the diagnosis date and expected return to duty date.
- Section 3: Physician Instructions. Record the full diagnosis and treatment plan. Note any restrictions on physical activity. Include the next scheduled evaluation date.
- Physician Certification. The physician signs and dates the completed form. Include the physician's full name, title, facility, and contact information.
How to Submit the Completed Form
Forward the completed DA Form 7574-1 to the soldier's unit commander. The unit processes it according to DA PAM 135-381 procedures. Keep a copy in the soldier's medical records. Late submission can affect incapacitation pay eligibility and processing timelines.
Frequently Asked Questions About DA Form 7574-1
Can a civilian doctor fill out DA Form 7574-1? No. Only a U.S. government or military physician is authorized to certify this form.
How long does the form cover? The form covers the dates specified by the physician. A new form is required when the incapacitation period extends beyond those dates.
What happens if the form is incomplete? Incomplete forms may delay incapacitation pay processing. The unit will return the form to the physician for corrections before submission.
Related Military and Medical Forms
These forms are commonly used alongside DA Form 7574-1: