DD Form 2808: Report of Medical Examination

In box 1, enter the date of examination (YYYYMMDD).

In box 2a, enter the social security number; in box 2b, enter the DoD ID number, if applicable.

In box 3, enter the last name, first name and middle name (Suffix).

In box 4, enter the home address (Street, Apartment Number, City, State and Zip Code).

In box 5a, enter the home telephone number (include area code); in box 5b, enter the e-mail address.

In box 6, enter the grade/rank.

In box 7, enter the date of birth (YYYYMMDD).

In box 8, enter the age; in box 9, check Male or Female.

In box 10, race and ethnicity, select all that apply: American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Middle Eastern or North African, Native Hawaiian or Pacific Islander, White, Other.

In box 11, total years government service, enter the years in a, military, and in b, civilian.

Box 12, agency, is for non-service members only. In box 13, enter the organization unit and UIC/code.

In box 14a, enter the rating or specialty (aviators only); in box 14b, enter the total flying time; in box 14c, enter the last six months.

In box 15a, check the service: Army, Air Force, Marine Corps, Navy, Coast Guard or USPHS. In box 15b, check the component: Active Duty, Reserve or National Guard. In box 15c, check the purpose of examination: Enlistment, Retirement, Commission, U.S. Service Academy, Retention, ROTC Scholarship Program, Separation, Medical Board or Other.

In box 16, enter the name of examining location and address (include zip code).

For the medical evaluation, check each item in the appropriate column (Normal, Abnormal or NE) for boxes 17 to 42. Enter NE if not evaluated.

Box 21, ears, general: Int. and ext. canals; Auditory acuity under item 71. Box 28, lungs and chest: include breasts. Box 30, anus and rectum (Hemorrhoids, Fistulae): prostate if indicated. Box 31, abdomen and viscera: include hernia. Box 34, lower extremities: except feet. Box 40, psychiatric: specify any personality disorder. Box 41, pelvic: females only.

In box 35, feet, check category: in 35a, Normal Arch, Pes Planus, Pes Cavus; in 35b, Mild, Moderate, Severe; in 35c, Asymptomatic, Symptomatic, Rigid.

In box 43, dental defects and disease, check Acceptable or Not Acceptable and enter the Class. Please explain. Use dental form if completed by dentist. If abnormality noted, explain in item 44.

In box 44, notes, a comment is mandatory for every abnormality identified in items 17 to 43: enter the pertinent item number before each comment. Continue comments or use drawings in item 89 and use additional sheets if necessary.

Under laboratory findings, in box 45, urinalysis, enter albumin in a and sugar in b; in box 46, enter urine HCG; in box 47, enter H/H; in box 48, enter blood type.

In boxes 49 to 52, enter the tests and results for HIV, drugs, alcohol and other, with a. PAP SMEAR, b. EKG and c. CXR.

Under measurements and other findings, enter height (in.) in box 53, weight (lbs.) in box 54, MIN WGT in box 55a, MAX WGT in box 55b, MAX BF % in box 55c, BMI in box 55d, temperature in box 56 and heart rate in box 57.

In box 58, blood pressure, enter SYS. and DIAS. for a. 1ST, b. 2ND and c. 3RD.

Enter box 59, red/green, and box 60, other vision test.

In box 61, distance vision, enter Right Uncorr. 20/ and Corr. to 20/, and Left Uncorr. 20/ and Corr. to 20/.

In box 62, refraction, check AUTO, MANIFEST or CYCLO and enter Sph:, Cyl and Axis.

In box 63, near vision, enter Right Uncorr. 20/ and Corr. to 20/, then Add:; and enter Left Uncorr. 20/ and Corr. to 20/, then Add.

In box 64, heterophoria, enter ES, EX, R.H., L.H., Prism div., Prism Conv, CT, NPR and PD.

In box 65, accommodation, enter Right and Left. In box 66, color vision, enter Pass/Fail and Score for PIP, RED/GRE and Color Dx. In box 67, depth perception, enter Pass/Fail and Score for AFVT and RANDOT/M.

Enter box 68, field of vision, box 69, night vision, and box 70, intraocular pressure (O.D. and O.S.).

In box 71a, audiometer, and in box 71b, enter the unit serial number and the date calibrated (YYYYMMDD), then enter Left and Right at HZ 500, 1000, 2000, 3000, 4000 and 6000.

In box 72a, reading aloud test, and in box 72b, Valsalva, mark SAT or UNSAT.

In box 72c, enter other testing; in box 73, enter notes and/or interval history.

In box 74, check EXAMINEE IS MEDICALLY QUALIFIED or EXAMINEE IS NOT MEDICALLY QUALIFIED.

Box 75: I have been advised of my disqualifying condition(s). Sign, and enter the date in box 75b (YYYYMMDD).

In box 76, physical profile, enter PUL HES X D, profiler initials and the date (YYYYMMDD).

In box 77, significant or disqualifying medical diagnoses, enter the item number, medical diagnosis, ICD code, profile serial, RBJ date (YYYYMMDD), qualified, disqualified and examiner initials. Under waiver received, enter the service and the date (YYYYMMDD).

In box 78, summary of medical diagnoses, list diagnoses with item numbers. In box 79, specify recommendations. For both, use additional sheets if necessary.

Box 80, MEPS workload, is for MEPS use only.

In box 81, medical inspection, enter DATE, HT, WT, %BF, MAX WT, HCG, QUAL and DISQ, then the examiner's name and signature.

In boxes 82a and 83a, enter the typed or printed name of the physician or examiner; in box 84a, of the dentist or physician (indicate which); in box 85a, of the reviewing officer/approving authority (indicate which). The form prints a SIGN line with each of boxes 82, 83, 84 and 85.

Box 86: This examination has been administratively reviewed for completeness and accuracy. The box has a SIGN line, the grade in b and the date (YYYYMMDD) in c.

In box 87, waiver granted, check YES or NO; if yes, enter the date and by whom. In box 88, enter the number of attached sheets.

In box 89, enter the additional remarks.

DD Form 2808, the Report of Medical Examination, obtains medical data to determine medical fitness for enlistment, induction, appointment and retention of applicants and members of the Armed Forces. Disclosure is voluntary; however, failure by an applicant to provide the information may result in delay or possible rejection of the individual's application to enter the Armed Forces.