Dd Form 2992 PDF Details

Embarking on a journey into the realm of aviation or special operational duty within the military introduces service members to a crucial document: the DD Form 2992. This particular form plays a pivotal role in assessing the medical fitness of military personnel for their designated roles, encapsulating elements ranging from identity and organizational affiliation to the specific nature of duties and an exhaustive medical evaluation. It not merely records the outcome of a flight physical examination but also delineates recommendations regarding an individual's capability to undertake flying responsibilities, indicating whether temporary or permanent medical disqualifications are in effect, or if waivers are recommended or granted. The form, reflective of a rigorous privacy policy and established military standards, serves as a communication bridge between medical authorities and command structures, ensuring that the health-related aspects of operational readiness are thoroughly evaluated and documented. Moreover, it encompasses provisions for both qualification for flight duty and restrictions due to medical reasons, integrating the insights of medical professionals alongside the service member's acknowledgment of understanding their medical recommendations. As a tool that facilitates the management of aviation personnel's medical fitness, the DD Form 2992 embodies a critical process that underscores the interplay between individual health status and operational effectiveness in the military.

QuestionAnswer
Form NameDd Form 2992
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesaf 2992, af form 2992, dd 2992 fillable, da 2992

Form Preview Example

MEDICAL RECOMMENDATION FOR FLYING OR SPECIAL OPERATIONAL DUTY

(Read Privacy Act Statement and Instructions on back before completing form.)

1. TO:

2. FROM:

3.DATE (YYYYMMDD)

4.

MEMBER NAME (Last, First, Middle Initial)

5. IDENTIFICATION NUMBER

6. GRADE

7. DATE OF BIRTH

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

8.

ORGANIZATION

9. TYPE OF DUTY

10. FLIGHT PHYSICAL DATE (YYYYMMDD)

 

 

 

(If applicable)

 

 

 

 

 

 

11.UP: THE ABOVE INDIVIDUAL HAS BEEN FOUND QUALIFIED BY MEDICAL AUTHORITY.

a. X one:

 

 

 

 

 

CLEARED AFTER (X):

 

Temporary medical disqualification

 

Waiver recommended (Not USAF)

 

 

 

 

 

 

Reporting to new duty station

 

Waiver granted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLEARED AFTER FLIGHT DUTY MEDICAL EXAMINATION

 

 

 

 

 

 

 

 

 

 

 

Aircraft mishap Other (See remarks)

b. EFFECTIVE DATE (YYYYMMDD)

c. EXPIRATION DATE (YYYYMMDD)

12.DOWN: THE ABOVE INDIVIDUAL HAS BEEN FOUND DISQUALIFIED BY MEDICAL AUTHORITY.

a. X one:

 

 

 

 

 

 

 

 

TEMPORARY DISQUALIFICATION DUE TO (X):

 

Illness or Injury

 

 

Aircraft mishap

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAY PARTICIPATE IN (X):

 

Simulator duties

 

 

Ground based flight line duties

 

 

 

 

 

 

 

 

 

 

 

PERMANENT DISQUALIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other (See remarks) Other (See remarks)

b. EFFECTIVE DATE (YYYYMMDD)

c. ESTIMATED DURATION OF GROUNDING

13. REMARKS/LIMITATIONS

VISION CORRECTION DEVICES REQUIRED IN THE PERFORMANCE OF FLIGHT DUTIES.

MUST CARRY EXTRA SPECTACLES.

 

 

 

 

 

 

 

 

 

 

14.

(X one):

 

FLIGHT SURGEON

 

OTHER (Countersignature required for Air Force and Navy upslip)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. TYPED NAME (Last, First, Middle Initial)

 

 

b. GRADE

c. PROVIDER SIGNATURE

d. DATE SIGNED

 

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e. TYPED NAME (Last, First, Middle Initial)

 

 

f. GRADE

g. FLIGHT SURGEON COUNTERSIGNATURE

h. DATE SIGNED

 

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

MEMBER CERTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. I certify that I understand the above recommendations and that I:

MAY

 

MAY NOT

perform flight duties.

 

 

 

 

b. AIRCREW MEMBER SIGNATURE

c.DATE SIGNED

(YYYYMMDD)

16. ACTION TAKEN BY COMMANDER (Not required for Air Force and Navy)

 

 

 

APPROVE

 

DISAPPROVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. TYPED NAME (Last, First, Middle Initial)

b. TITLE

c. SIGNATURE

 

 

d. DATE SIGNED

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DD FORM 2992, JAN 2015

REPLACES DA FORM 4186, AF FORM 1042, AND NAVMED FORMS 6410/1 AND 6410/2,

Adobe Designer 9.0

WHICH ARE OBSOLETE.

 

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 3031, Secretary of the Army; 10 U.S.C. 5013, Secretary of the Navy; 10 U.S.C. 8013, Secretary of the Air Force; 14 U.S.C. 92, Secretary, General Powers; AR 40-501 Standards of Medical Fitness, AFI 48-123 Medical Examinations and Standards, OPNAVINST 3710 NATOPS General Flight and Operating Instruction, and COMDTINST M6410.3A, Coast Guard Aviation Medicine Manual.

PRINCIPAL PURPOSE(S): This form is used to inform the commander about medical fitness to perform flying or special operational duty. It is also used to populate the service specific flight records management system used by the Army, Air Force and Navy.

ROUTINE USE(S):

Law Enforcement Routine Use: If a system of records maintained by a Component to carry out its functions indicates a violation or potential violation of law, whether civil, criminal, or regulatory in nature, and whether arising by general statute or by regulation, rule, or order issued pursuant thereto, the relevant records in the system of records may be referred, as a routine use, to the agency concerned, whether Federal, State, local, or foreign, charged with the responsibility of investigating or prosecuting such violation or charged with enforcing or implementing the statute, rule, regulation or order pursuant thereto.

Congressional Inquiries Disclosure Routine Use: Disclosure from a system of records maintained by a Component may be made to a congressional office from the record of an individual in response to an inquiry from the congressional office made at the request of that individual.

Disclosure to the Department of Justice for Litigation Routine Use: A record from a system of records maintained by a Component may be disclosed as a routine use to any component of the Department of Justice for the purpose of representing the Department of Defense or the U.S. Coast Guard, or any officer, employee or member of these entities in pending or potential litigation to which the record is pertinent.

Disclosure of Information to the National Archives and Records Administration Routine Use: A record from a system of records maintained by a Component may be disclosed as a routine use to the National Archives and Records Administration for the purpose of records management inspections conducted under authority of 44 U.S.C. 2904 and 2906.

Data Breach Remediation Purposes Routine Use: A record from a system of records maintained by a Component may be disclosed to appropriate agencies, entities, or persons when (1) the Component suspects or has confirmed that the security or confidentiality of the information in the system of records has been compromised; (2) the Component has determined that as a result of the suspected or confirmed compromise there is a risk of harm to economic or property interests, identity theft or fraud, or harm to the security or integrity of this system or other systems or programs (whether maintained by the Component or another agency or entity) that rely upon the compromised information; and (3) the disclosure made to such agencies, entities, and persons is reasonably necessary to assist in connection with the Components efforts to respond to the suspected or confirmed compromise and prevent, minimize, or remedy such harm.

DISCLOSURE: Voluntary. Failure to provide information or sign may delay determination of medical fitness to perform flying or special operational duty.

INSTRUCTIONS

Blocks 1-8: These may be completed by the clinic staff or the service member.

Block 5: Identification Number

a. Air Force, Army and Navy – Use DoD ID number. b. Coast Guard – Use Employee ID number.

Block 9: Place the Flying Class category and the duty performed using the references below.

Army – See AR 40-501, Chapter 6.

Air Force – See AFI 48-123, Chapter 6.

Navy – See NAVMED P-117, Chapter 15, Article 15-63.

Coast Guard – See Coast Guard Aviation Medicine Manual, Chapter 1.

Block 10 – Date flight physical was completed.

Block 11 (a-c) – This section is used for qualification. Mark the appropriate boxes.

Block 12 (a-c) – This section is used for disqualification. Mark the appropriate boxes.

Block 13 – Make remarks as appropriate and do not include any protected health information in this section.

Blocks 14 – 16 are self-explanatory except as detailed below.

Block 14 – Other credentialed providers who are not flight surgeons require a countersignature by a flight surgeon. Army aeromedical physician assistants and aviation medicine nurse practitioners do not require a countersignature for Army personnel only.

Block 15 – Selecting "MAY NOT" does not prohibit simulator duties or ground based flight line duties if these boxes are marked in block 12.

DD FORM 2992 (BACK), JAN 2015

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