Dd Form 2697 – Fill Out and Use This PDF

The DD Form 2697 serves as a detailed document used by Medical Services to conduct a comprehensive medical assessment for active and reserve component service members who are separating or retiring from active duty. This important form not only facilitates a smooth transition for service members but also ensures their health concerns are adequately addressed and documented, aiding in any potential disability claims with the Department of Veterans Affairs. To ensure a thorough and accurate reporting of one’s medical status, filling out the DD Form 2697 is a proactive step towards securing one's health and future.

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Dd Form 2697 PDF Details

The DD Form 2697, known as the Report of Medical Assessment, plays a crucial role in the transition process for service members separating or retiring from active duty, including those in the reserve components. Authorized under PL 103-160 and Executive Order 9397, this comprehensive form serves multiple purposes, primarily to ensure a service member's health is thoroughly evaluated before their departure from military service. By providing a detailed medical assessment, it not only aids in the smooth transition of individuals back into civilian life but also facilitates any claims with the Department of Veterans Affairs (VA) for disabilities incurred during service. The form requires service members to disclose their health status, any illnesses, injuries, medication use, and whether they intend to seek VA disability, among other health-related questions. Health care providers complete a section of the form as well, documenting any physical findings and recommending further evaluation if necessary. Essentially, this form is a vital step in ensuring that the health concerns of service members are addressed before they leave active duty, and it assists in establishing a clear medical record for future reference.

Question	Answer
Form Name	Dd Form 2697
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	assessment any last sample, medical assessment physical form, report of medical assessment form, medical assessment physical template

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REPORT OF M EDICAL ASSESSM ENT

REPORT CONTROL SYM BOL

PRIVACY ACT STATEM ENT

AUTHORITY: PL 103 -160, EO 9397 .

PRINCIPAL PURPOSE: To be used by t he Medical Services t o provide a comprehensive medical assessment f or act ive and reserve component service members separat ing or ret iring f rom act ive dut y.

ROUTINE USES: A copy of t his f orm w ill be released t o t he Depart ment of Vet erans Af f airs.

DISCLOSURE: Volunt ary; how ever, f ailure t o disclose t he request ed personal inf ormat ion may result in delay in processing any disabilit y claim.

SECTION I - TO BE COM PLETED BY SERVICE M EM BER. Any service member w ho requests a physical examination may have one.

1 . NAM E (Last , First , Middle)

2 . SOCIAL SECURITY NUM BER

3 . RANK

4 . COM PONENT	5 . UNIT OF ASSIGNM ENT

6a. HOM E STREET ADDRESS (Or RFD, including	b. CITY	c. STATE	d. ZIP CODE	7 . HOM E TELEPHONE NUM BER
apart ment number)				(Include area code)

8 . DATE OF LAST PHYSICAL EXAM INATION BY THE M ILITARY		9 . DATE ENTERED ON CURRENT ACTIVE DUTY (YYMMDD)
(YYMMDD)

10 . COM PARED TO M Y LAST M EDICAL ASSESSM ENT/PHYSICAL EXAM INATION, M Y OVERALL HEALTH IS (X one. If " Worse," explain.)

THE SAM E

BETTER

WORSE

11 . SINCE YOUR LAST M EDICAL ASSESSM ENT/PHYSICAL EXAM INATION, HAVE YOU HAD ANY ILLNESSES OR INJURIES THAT CAUSED YOU TO M ISS DUTY FOR LONGER THAN 3 DAYS? (X one. If " Yes," explain.)

YES

12 . SINCE YOUR LAST M EDICAL ASSESSM ENT/PHYSICAL EXAM INATION, HAVE YOU BEEN SEEN BY OR BEEN TREATED BY A HEALTH CARE PROVIDER, ADM ITTED TO A HOSPITAL, OR HAD SURGERY? (X one. If " Yes," explain.)

YES

13 . HAVE YOU SUFFERED FROM ANY INJURY OR ILLNESS WHILE ON ACTIVE DUTY FOR WHICH YOU DID NOT SEEK M EDICAL CARE?

(X one. If " Yes," explain.)

YES

14 . ARE YOU NOW TAKING ANY M EDICATIONS? (X one. If " Yes," list medicat ions.)

YES

15 . DO YOU HAVE ANY CONDITIONS WHICH CURRENTLY LIM IT YOUR ABILITY TO WORK IN YOUR PRIM ARY M ILITARY SPECIALTY OR REQUIRE GEOGRAPHIC OR ASSIGNM ENT LIM ITATIONS? (X one. If " Yes," explain.)

YES

16 . DO YOU HAVE ANY DENTAL PROBLEM S? (X one. If " Yes," explain.)

YES

17 . DO YOU HAVE ANY OTHER QUESTIONS OR CONCERN ABOUT YOUR HEALTH? (X one. If " Yes," explain.)

YES

18 . AT THE PRESENT TIM E, DO YOU INTEND TO SEEK DEPARTM ENT OF VETERANS AFFAIRS (VA) DISABILITY?

(X one. If " Yes," list condit ions f or w hich you w ill ask f or VA Disabilit y.)

YES

UNCERTAIN

19 . CERTIFICATION. I certify that the information provided above is true and complete to the best of my know ledge.

a. SIGNATURE OF SERVICE M EM BER	b. DATE SIGNED

DD FORM 2697, FEB 95 (EG)

Designed using Perf orm Pro, WHS/DIOR, Feb 95

SECTION II - TO BE COM PLETED BY INDIVIDUALLY PRIVILEGED HEALTH CARE PROVIDER

This Report of Medical Assessment is t o be used by t he Medical Services t o provide a comprehensive medical assessment f or act ive and reserve component service members separat ing or ret iring f rom act ive dut y. The assessment w ill cover, as a minimum, t he period since t he service member' s last medical assessment /physical examinat ion, or t he period of t his call or order t o act ive dut y. Any service member w ho request s a physical examinat ion may have one. Any service member w ho has indicat ed " yes" t o It em 18 w ill have an appropriat e physical examinat ion, if t he last examinat ion is more t han 12 mont hs old and/or t here are new signs and/or sympt oms. If t he service member answ ers

"Worse" t o It em 10 or " Yes" t o It ems 11, 12, or 14 t hrough 18, document at ion of t he injury, illness, or problem should be included in t he service member' s medical or dent al record.

20 . HEALTH CARE PROVIDER COM M ENTS (All pat ient complaint s must be addressed)

21 . WAS PATIENT REFERRED FOR FURTHER EVALUATION? (X one. If " Yes," specif y w here.)

YES

22 . PURPOSE OF ASSESSM ENT (X one. If " Ot her," explain.)

SEPARATION (Includes discharge f rom milit ary service and release f rom act ive dut y, including release of Nat ional Guard and Reserve personnel volunt arily or involunt arily called or ordered t o act ive dut y.)

RETIREM ENT

OTHER

23 . M EDICAL FACILITY

24 . DATE OF ASSESSM ENT

(YYMMDD)

25 . HEALTH CARE PROVIDER

a. NAM E (Last , First , Middle Init ial)	b. GRADE/RANK	c. SIGNATURE

DD FORM 2697, FEB 95 (BACK)

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Pay attention when completing this form. Make certain all necessary blank fields are filled out correctly.

1. To begin with, while completing the medical assessment physical, beging with the section that contains the subsequent fields:

The right way to prepare report of medical assessment portion 1

2. Just after filling out this step, go to the next part and enter the essential particulars in all these blanks - SINCE YOUR LAST MEDICAL, YES, SINCE YOUR LAST MEDICAL, YES, HAVE YOU SUFFERED FROM ANY INJURY, YES, ARE YOU NOW TAKING ANY, YES, DO YOU HAVE ANY CONDITIONS WHICH, YES, DO YOU HAVE ANY DENTAL PROBLEMS X, and YES.

YES, YES, and YES of report of medical assessment

3. Completing DO YOU HAVE ANY OTHER QUESTIONS, YES, AT THE PRESENT TIME DO YOU INTEND, YES, UNCERTAIN, CERTIFICATION I certify that the, b DATE SIGNED, DD FORM FEB EG, and Designed using Perform Pro WHSDIOR is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

How to complete report of medical assessment part 3

4. Now fill in this next section! Here you've got all these HEALTH CARE PROVIDER COMMENTS All fields to complete.

The best ways to complete report of medical assessment step 4

Always be extremely mindful while filling out HEALTH CARE PROVIDER COMMENTS All and HEALTH CARE PROVIDER COMMENTS All, because this is where many people make a few mistakes.

5. Finally, the following final portion is precisely what you will need to finish prior to submitting the form. The fields at issue are the next: WAS PATIENT REFERRED FOR FURTHER, YES, PURPOSE OF ASSESSMENT X one If, SEPARATION Includes discharge from, RETIREM ENT, OTHER, M EDICAL FACILITY, DATE OF ASSESSMENT YYMMDD, HEALTH CARE PROVIDER a NAME Last, b GRADERANK, c SIGNATURE, and DD FORM FEB BACK.

b GRADERANK, SEPARATION Includes discharge from, and OTHER inside report of medical assessment

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Dd Form 2697 – Fill Out and Use This PDF

Dd Form 2697 PDF Details

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