The DD Form 139, also known as the Report of Medical Examination, is a document used by the military to track the health and medical history of its members. The form is filled out by a military doctor upon examination of a member, and includes information on any medical conditions or injuries that have been observed. The DD Form 139 is an important tool for tracking the health of military personnel, and assists in ensuring that they are able to serve effectively.
| Question | Answer |
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| Form Name | Dd Form 139 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Disbursing, dd 139 form, dd139, dd form 139 fillable |
PAY ADJUSTMENT AUTHORIZATION |
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NOTE: If member has been transferred, forward this authorization to the |
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officer currently maintaining the member's pay record. |
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MEMBER (Last name) |
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(Middle) |
SSAN |
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GRADE/RANK/RATE |
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BRANCH OF SERVICE |
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DATE |
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PAY GRADE NO. |
LAST PAY RECORD EXAMINED |
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AMOUNT |
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APPROPRIATION DATA |
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FROM |
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NAME OF ACCOUNTABLE D.O. |
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SYMBOL NO. |
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G.A.O. EXCEPTION CODE |
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YOU ARE HEREBY AUTHORIZED TO |
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CHARGE |
CREDIT |
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THE MILITARY PAY RECORD OF THE |
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MEMBER LISTED ABOVE |
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EXPLANATION AND/OR REASON FOR ADJUSTMENT |
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The above adjustment is based on a thorough examination of all available records. If the Disbursing Officer has knowledge that a previous adjustment has been made or why the adjustment should not be made for the same item, this authorization should be returned with a brief statement of the reason for failure to make adjustment.
FROM
CERTIFYING OFFICER (Name, rank/grade, and signature)
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I CERTIFY that the adjustment indicated above has been entered on the |
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entered, give explanation on reverse over D.O.'s signature and symbol number.) |
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TYPED NAME AND GRADE OF D.O. |
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D.O. SYMBOL NO. |
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SIGNATURE |
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DD FORM 139, MAY 53 |
EDITION OF THIS FORM NOT HAVING SSAN IS OBSOLETE AFTER 30 JUN 69. |
Form approved by Comp. Gen., U.S. |
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April 23, 1953
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