Dd Form 2808 PDF Details

The Department of Defense (DOD) Form 2808, also known as the Report of Casualty, is a document used to report the death or injury of a member of the United States Armed Forces. The form is used by military personnel, casualty assistance officers, and family members to provide information about the incident. The report must be filed within 72 hours of the casualty event. The DOD Form 2808 is a critical piece of documentation in regards to military casualties. It provides essential information about the event, and can be used to help track and monitor injuries and fatalities. Families of service members who have been injured or killed may also use the form to apply for benefits through the Department of Veterans Affairs. If you are a service member

QuestionAnswer
Form NameDd Form 2808
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesdd 2808 army pubs, dd form 2808 updated 2019, dd2808, 2808 form

Form Preview Example

Prescribed by: DoDI 1304.2

REPORT OF MEDICAL EXAMINATION

1. DATE OF EXAMINATION

2a. SOCIAL SECURITY NUMBER

2b. DoD ID NUMBER

(YYYYMMDD)

 

(If applicable)

 

 

 

 

 

PRIVACY ACT STATEMENT

 

 

AUTHORITY: 10 U.S.C. 504, Persons not qualified; 10 U.S.C. 505, Regular components: qualifications, term, grade; 10 U.S.C. 507, Extension of enlistment for members needing medical care or hospitalization; 10 U.S.C. 532, Qualifications for original appointment as a commissioned officer; 10 U.S.C. 978, Drug and alcohol abuse and dependency: testing of new entrants; 10 U.S.C. 1201, Regulars and members on active duty for more than 30 days: retirement; 10 U.S.C. 1202, Regulars and members on active duty for more than 30 days: temporary disability retired list; 10 U.S.C. 4346, Cadets: requirements for admission; DoD Directive 1145.2, United States Military Entrance Processing Command; E.O. 9397 (SSN) and 10 U.S.C. 1204, Members on Active Duty for 30 Days or Less or on Inactive Duty Training: Retirement, as amended.

PRINCIPAL PURPOSE(S): To obtain medical data for determination of medical fitness for enlistment, induction, appointment and retention for applicants and members of the Armed Forces. The information will also be used for medical boards and separation of Service members from the Armed Forces.

ROUTINE USE(S): The Routine Uses are listed in the applicable system of records notice found at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/ Article/570661/a0601-270-usmepcom-dod/

DISCLOSURE: 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. For an Armed Forces member, failure to provide the information may result in the individual being placed in a non-deployable status.

3. LAST NAME - FIRST NAME - MIDDLE NAME

 

 

 

 

 

4. HOME ADDRESS (Street, Apartment Number, City,

 

 

5a. HOME TELEPHONE

5b. E-MAIL ADDRESS

(Suffix)

 

 

 

 

 

 

 

 

 

 

 

 

State and Zip Code)

 

 

 

 

 

 

 

 

NUMBER (Include Area Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. GRADE/

7. DATE OF BIRTH

8. AGE

9a. BIRTH SEX

9b. PREFERRED GENDER

10a. ETHNIC CATEGORY

10b. RACIAL CATEGORY (Select one)

RANK

 

(YYYYMMDD)

 

 

 

 

 

Male

 

 

Male

 

 

 

Hispanic/Latino

 

 

American Indian or Alaska Native

 

 

Asian

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

 

Female

 

 

 

Non Hispanic/Latino

 

 

Black or African American

 

 

White

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Native Hawaiian or Other Pacific Islander

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. TOTAL YEARS GOVERNMENT SERVICE

12. AGENCY (Non-Service Members Only)

 

 

 

 

 

 

 

 

13. ORGANIZATION UNIT AND UIC/CODE

 

 

 

 

 

 

a. MILITARY

 

b. CIVILIAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14a. RATING OR SPECIALTY (Aviators Only)

 

 

 

 

 

 

14b. TOTAL FLYING TIME

 

 

 

 

 

 

 

 

 

14c. LAST SIX MONTHS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15a. SERVICE

 

 

15b. COMPONENT

 

15c. PURPOSE OF EXAMINATION

 

 

 

 

 

 

 

16. NAME OF EXAMINING LOCATION, AND ADDRESS

Army

 

 

 

 

Active Duty

 

 

 

 

Enlistment

 

 

Retirement

 

 

 

 

 

 

 

 

(Include Zip Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commission

 

 

U.S. Service Academy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Air Force

 

 

 

 

Reserve

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Retention

 

 

ROTC Scholarship Program

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Marine Corps

 

 

 

 

National Guard

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Separation

 

 

Medical Board

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Navy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Coast Guard

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MEDICAL EVALUATION (Check each item in appropriate column. Enter "NE" if not evaluated.)

 

 

 

 

 

 

 

43. DENTAL DEFECTS AND DISEASE

Acceptable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Please explain. Use dental form if

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Normal Abnormal

NE

 

completed by dentist. If abnormality noted,

Not Acceptable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17. Head, face, neck and scalp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

explain in item 44.)

 

Class

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18. Nose

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19. Sinuses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

44. NOTES: (Mandatory comment for every abnormality identified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

in items 17 - 43. Enter pertinent item number before each comment.

20. Mouth and throat

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Continue comments or use drawings in item 89 and use additional

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21. Ears - General (Int. and ext. canals/Auditory acuity under item 71)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

sheets if necessary.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22. Tympanic Membranes (Perforation)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23. Eyes - General

24. Ophthalmoscopic

25. Pupils (Equality and reaction)

26. Ocular motility (Associated parallel movements, nystagmus)

27. Heart (Thrust, size, rhythm, sounds)

28. Lungs and chest (Include breasts)

29. Vascular system (Varicosities, etc.)

30. Anus and rectum (Hemorrhoids, Fistulae) (Prostate if indicated)

31. Abdomen and viscera (Include hernia)

32. External genitalia (Genitourinary)

33. Upper extremities

34. Lower extremities (Except feet)

35. Feet (Check category)

35a.

 

Normal Arch

 

Pes Planus

 

Pes Cavus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35b.

 

Mild

 

Moderate

 

Severe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35c.

 

Asymptomatic

 

Symptomatic

 

Rigid

 

 

 

 

 

 

 

 

 

36. Spine, other musculoskeletal

37. Body marks, scars, tattoos

38. Skin, lymphatics

39. Neurologic

40. Psychiatric (Specify any personality disorder)

41. Pelvic (Females only)

42. Endocrine

DD FORM 2808, July 2019

Page 1 of 4

Prescribed by: DoDI 1304.2

LAST NAME - FIRST NAME - MIDDLE NAME (Suffix)

SOCIAL SECURITY NUMBER

DoD ID NUMBER

LABORATORY FINDINGS

45. URINALYSIS

a. Albumin

b. Sugar

46. URINE HCG

47. H/H

48. BLOOD TYPE

TESTS

RESULTS

HIV SPECIMEN ID LABEL

DRUG TEST SPECIMEN ID LABEL

 

 

 

 

49. HIV

 

 

 

 

 

 

 

50. DRUGS

 

 

 

 

 

 

 

51. ALCOHOL

 

 

 

 

 

 

 

52. OTHER

 

 

 

 

 

 

 

a. PAP SMEAR

 

 

 

 

 

 

 

b. EKG

 

 

 

 

 

 

 

c. CXR

 

 

 

 

 

 

 

MEASUREMENTS AND OTHER FINDINGS

53. HEIGHT (in.)

 

54. WEIGHT (lbs.)

 

55a. MIN WGT

 

 

55b. MAX WGT

 

 

 

55c. MAX BF %

 

55d. BMI

 

 

56. TEMPERATURE

57. HEART RATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

58. BLOOD PRESSURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

59. RED/GREEN

 

 

 

 

 

60. OTHER VISION

TEST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. 1ST

 

 

 

 

 

 

b. 2ND

 

 

 

 

c. 3RD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SYS.

 

 

 

 

 

 

SYS.

 

 

 

 

SYS.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DIAS.

 

 

 

 

 

 

DIAS.

 

 

 

 

DIAS.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

61. DISTANCE VISION

 

62. REFRACTION

 

 

 

 

 

AUTO

 

 

 

 

MANIFEST

 

CYCLO

63. NEAR VISION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Right Uncorr.

 

 

 

 

Corr. to 20/

 

Sph:

 

 

 

Cyl:

 

 

 

 

 

 

 

 

 

 

 

Axis:

 

 

Right Uncorr.

 

 

 

Corr. to 20/

 

Add:

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Left Uncorr.

 

 

 

 

Corr. to 20/

 

Sph:

 

 

 

Cyl:

 

 

 

 

 

 

 

 

 

 

 

Axis:

 

 

Left Uncorr.

 

 

 

Corr. to 20/

 

Add:

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

64. HETEROPHORIA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ES

 

 

 

EX

R.H.

 

L.H.

 

 

 

 

 

 

Prism

 

 

Prism

 

 

NPR

 

 

 

 

 

 

 

PD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

div.

 

 

Conv CT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

65. ACCOMMODATION

66. COLOR VISION (Pass/Fail and Score)

 

 

 

 

67. DEPTH PERCEPTION (Pass/Fail and Score)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Right

 

 

 

Left

PIP

 

 

 

RED/

 

 

 

 

Color

 

 

 

 

AFVT

 

 

 

 

 

 

 

 

RANDOT/

 

 

 

 

 

 

 

 

 

 

GREEN

 

 

 

 

Dx

 

 

 

 

 

 

 

 

 

 

 

 

MCST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

68. FIELD OF VISION

 

 

 

 

 

 

 

69.

NIGHT VISION

 

 

 

 

 

 

 

 

 

 

 

 

70. INTRAOCULAR PRESSURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O.D.

 

 

 

 

 

 

 

 

O.S.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

71a. AUDIOMETER Unit Serial Number

 

 

 

71b. Unit Serial Number

 

 

 

 

 

72a. READING

 

 

 

 

 

SAT

 

 

 

UNSAT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALOUD TEST:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Calibrated (YYYYMMDD)

 

 

 

Date Calibrated (YYYYMMDD)

 

 

 

 

 

72b.

 

 

 

 

 

 

 

 

SAT

 

 

 

UNSAT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VALSALVA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HZ

 

500

 

 

1000

2000

3000

4000

6000

 

 

HZ

 

500

 

 

1000

2000

 

3000

4000

6000

72c. OTHER TESTING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Left

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Left

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Right

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Right

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

73. NOTES AND/OR INTERVAL HISTORY

DD FORM 2808, July 2019

Page 2 of 4

Prescribed by: DoDI 1304.2

LAST NAME - FIRST NAME - MIDDLE NAME (Suffix)

 

 

SOCIAL SECURITY NUMBER

 

DoD ID NUMBER

 

 

 

 

 

 

 

 

74. EXAMINEE

 

 

 

75.

I have been advised of my disqualifying condition(s).

 

 

IS MEDICALLY QUALIFIED

 

 

 

75a. SIGNATURE OF EXAMINEE

 

75b. DATE (YYYYMMDD)

 

 

IS NOT MEDICALLY QUALIFIED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

76. PHYSICAL PROFILE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P

U

L

H

E

S

X

D

PROFILER INITIALS DATE (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

77. SIGNIFICANT OR DISQUALIFYING MEDICAL DIAGNOSES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM

MEDICAL DIAGNOSIS

ICD CODE

PROFILE SERIAL

RBJ DATE

QUALIFIED

DISQUALIFIED

EXAMINER INITIALS

WAIVER RECEIVED

NO.

(YYYYMMDD)

SERVICE

DATE (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

78.SUMMARY OF MEDICAL DIAGNOSES (List diagnoses with item numbers) (Use additional sheets if necessary).

79.RECOMMENDATIONS (Specify) (Use additional sheets if necessary).

80.MEPS WORKLOAD (For MEPS use only)

WKID

ST

DATE (YYYYMMDD)

INITIALS

WKID

ST

DATE (YYYYMMDD)

INITIALS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

81. MEDICAL INSPECTION DATE

HT

WT

%BF

MAX WT

HCG

QUAL

DISQ

EXAMINER'S NAME AND SIGNATURE

82a. TYPED OR PRINTED NAME OF PHYSICIAN OR EXAMINER

 

 

82b. Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

83a. TYPED OR PRINTED NAME OF PHYSICIAN OR EXAMINER

 

 

83b. Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

84a. TYPED OR PRINTED NAME OF DENTIST OR PHYSICIAN (Indicate which)

84b. Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

85a. TYPED OR PRINTED NAME OF REVIEWING OFFICER/APPROVING AUTHORITY

 

 

 

 

 

 

 

 

 

(Indicate which)

 

 

85b. Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

86. This examination has been administratively reviewed for completeness and accuracy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. SIGNATURE

b. GRADE

 

 

 

 

c. DATE (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

87. WAIVER GRANTED (If yes, date and by whom)

 

YES

 

 

 

NO

 

 

88. NUMBER OF

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTACHED SHEETS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DD FORM 2808, July 2019

Page 3 of 4

Prescribed by: DoDI 1304.2

89. ADDITIONAL REMARKS

DD FORM 2808, July 2019

Page 4 of 4

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2. After the last part is complete, you have to add the needed particulars in a RATING OR SPECIALTY Aviators Only, b TOTAL FLYING TIME, c LAST SIX MONTHS, a SERVICE, b COMPONENT, c PURPOSE OF EXAMINATION, Army Air Force Marine Corps Navy, Active Duty Reserve National Guard, Enlistment Commission Retention, Other, Retirement US Service Academy ROTC, MEDICAL EVALUATION Check each item, Normal Abnormal, Head face neck and scalp Nose, and NAME OF EXAMINING LOCATION AND allowing you to go further.

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4. Filling out Prescribed by DoDI LAST NAME, SOCIAL SECURITY NUMBER, DoD ID NUMBER, URINALYSIS, a Albumin, b Sugar, LABORATORY FINDINGS URINE HCG, BLOOD TYPE, TESTS, RESULTS, HIV SPECIMEN ID LABEL, DRUG TEST SPECIMEN ID LABEL, HIV DRUGS ALCOHOL OTHER a PAP, HEIGHT in, and WEIGHT lbs is key in this next part - make sure you take your time and fill in each and every empty field!

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