Form 422 PDF Details

Understanding the intricacies of the AF IMT 422 form is crucial for individuals navigating the complexities of medical and physical evaluations within the United States federal system. Known as the Physical Profile Serial Report, this document plays a pivotal role in assessing the readiness and physical limitations of personnel, guiding decisions on assignments, duty restrictions, and even potential medical board evaluations. At its core, the form requires detailed input about the patient, including identification, grade, service component, medical conditions, and any existing physical defects or restrictions. Additionally, the 422 form determines whether an individual is fit for overseas assignments, facing retirement or separation, or eligible for remote or isolated tours, with clear indicators for temporary or permanent status changes. Beyond these evaluations, the form also facilitates the assignment of an Assignment Availability Code (AAC) when necessary, further directing career paths based on health and capability. The instructions for converting the form into a fillable, savable format online, as well as accessing demos and examples, underscore the evolving nature of handling such critical documentation in a digital age, ensuring accessibility and efficiency in managing one’s medical profile within the federal system. This digital enhancement not only streamlines the process but also ensures that individuals and healthcare providers can submit accurate and timely information crucial for career progression and health management.

QuestionAnswer
Form NameForm 422
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesaf form 422a, af form 422 physical profile serial report, af 422 pdf, air force form 422a

Form Preview Example

This is a web-optimized version of this form.

Download the original, full version:

www.usa-federal-forms.com/download.html

Convert any form into fillable, savable:

www.fillable.com

Learn how to use fillable, savable forms:

Demos: www.fillable.com/demos.html

Examples: www.fillable.com/examples.html

Browse/search 10's of 1000's of U.S. federal forms converted into fillable, savable: www.usa-federal-forms.com

 

 

 

 

PHYSICAL PROFILE SERIAL REPORT

 

 

 

PATIENT ID

(Use plastic card or type/print name)

 

 

 

GRADE

 

DATE

 

 

 

 

 

 

 

 

AFSC

 

SSN

 

 

 

 

 

 

 

 

UNIT

 

 

 

 

 

 

 

 

 

 

BASE

 

 

 

 

PROFILE

P

U

L

H

E

S

SUFFIX

 

BLOOD GROUP DATA

 

PREVIOUS

 

 

 

 

 

 

 

TYPE AND RH

 

REVISED

 

 

 

 

 

 

 

 

DEFICIENCY

 

 

 

 

 

 

 

 

 

G6PD

 

TEMPORARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

REVISED

 

 

 

 

 

 

 

 

SICKLE CELL TRAIT

 

 

 

 

 

 

 

HEMOGLOBIN-S

 

PERMANENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

RELEASE DATE OF TEMPORARY PROFILE OR DUTY RESTRICTION

 

WORLD-WIDE

 

YES

NO

 

 

 

 

 

 

 

 

 

 

INDIVIDUAL DEFECTS/RESTRICTIONS

 

 

 

PASSES COLOR

 

YES

NO

 

 

 

 

 

 

 

 

 

 

MEDICAL DEFECT/CONDITION REQUIRES MEB OR PEB PROCESSING. ASSIGNMENT AVAILABILITY CODE(AAC) 37 APPLIES.

As shown by examination or review of Health Record or current course of treatment, individual is cleared for

 

OVERSEAS ASSIGNMENT

 

RETIREMENT/SEPARATION WITHIN ONE (1) YEAR

 

 

 

 

 

REMOTE/ISOLATED TOUR

 

OTHER (Specify)

 

 

 

 

REMARKS

TYPED OR PRINTED NAME AND GRADE OF HEALTH CARE PROVIDER

SIGNATURE

 

 

 

 

 

 

 

TYPED OR PRINTED NAME AND GRADE OF PES MANAGER

 

SIGNATURE

 

 

 

 

 

 

 

TYPED OR PRINTED NAME AND GRADE OF PROFILE OFFICER

 

SIGNATURE

 

 

 

 

 

 

 

DPMUO

DPMUM

DPMU(R)

DPMPC

DPMAR

 

 

 

 

 

 

 

 

 

AF IMT 422, 19890401, V2

PREVIOUS EDITION WILL BE USED.

COPY 1 - HEALTH

How to Edit Form 422 Online for Free

It's very easy to complete the where to find af form 422. Our PDF editor was made to be easy-to-use and let you complete any document quickly. These are the actions to go through:

Step 1: Locate the button "Get Form Here" and press it.

Step 2: Once you have entered your where to find af form 422 edit page, you'll discover all actions you may use with regards to your template in the top menu.

Complete the following parts to fill out the document:

filling in how to air force 422 stage 1

Type in the necessary details in the MEDICAL DEFECTCONDITION REQUIRES, As shown by examination or review, OVERSEAS ASSIGNMENT, RETIREMENTSEPARATION WITHIN ONE, REMOTEISOLATED TOUR, Specify OTHER, REMARKS, TYPED OR PRINTED NAME AND GRADE OF, and SIGNATURE part.

Filling out how to air force 422 part 2

The program will ask you to include specific vital data to conveniently fill in the section TYPED OR PRINTED NAME AND GRADE OF, SIGNATURE, TYPED OR PRINTED NAME AND GRADE OF, SIGNATURE, TYPED OR PRINTED NAME AND GRADE OF, SIGNATURE, DPMUO, DPMUM, DPMUR, DPMPC, DPMAR, AF IMT V, PREVIOUS EDITION WILL BE USED, and COPY HEALTH.

Completing how to air force 422 stage 3

Step 3: Select the "Done" button. Now, it is possible to transfer your PDF file - save it to your electronic device or send it via electronic mail.

Step 4: Generate copies of the document - it may help you prevent possible future worries. And fear not - we cannot disclose or look at your information.

Watch Form 422 Video Instruction

Please rate Form 422

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .