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DOD has replaced the use of the SF 93 with the DD Form and DD Form is used by recruiters to pre-screen applicants. Commissioned Corps of the U.S. Public Health Service. General Instructions for Completing Medical Examination Forms. DD “Report of Medical History” . A DD Form is a Department of Defense form is used for gathering medical information for applicants to military service. The form is used by military.

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Find a military hospital or clinic Find a VA Facility.

Boxes 10 28077-1 19 ask you to indicate whether you have a history of specific medical conditions or illnesses. If you answer yes to any question in boxes 10 through 19, you must provide an explanation of the medical condition rorm the provided space in box 29 or attach additional sheets explaining each yes answer.

Put the examining location on box 5, giving the address of the location. A PDF reader is required for viewing. The examiner reviews your current health status and your complete medical history, including the DD Form Do not leave any answers blank, you must answer yes or no to each issue.

Although the Defense Health Fprm may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information 2087-1 you may find at these locations. Next provide your position, usual occupation, current medication, and allergies. You also may be interested in Before filling out the DD Formyou must first read the disclaimer and understand that you must answer truthfully to all questions or face criminal charges.


You are leaving Health. You may be complete it at a military hospital or clinic or at a VA facility. How do I schedule the exam?

Separation Health Assessment |

Fomr appearance of hyperlinks does not constitute endorsement by the Defense Health Agency of non-U. All your health records are shared with the VA.

Such links are provided consistent with the stated purpose of this website. DoD dda VA share results of the exam with each other. A physician must attest to your answers in boxes 10 through The DoD requires a separation history and physical examination to capture the complete medical history of Service Members and evaluate members filing a disability claim.

An additional collection of information using this form occurs when a Medical Evaluation Board is convened to determine the medical fitness of a current member and if separation is warranted. You can schedule the exam at any military hospital or clinic or VA facility.

Go through each medical issue and answer yes or no for each. The physician may from additional comments in box 30, adding additional information that they feel is important. The information collected on this form is used to assist DoD physicians in making determinations as to acceptability of applicants for military service and verifies disqualifying medical condition s noted on the prescreening form DD The form is used by military physicians to determine if an applicant can be accepted or should be disqualified on medical grounds.

This is to see if you need further treatment or evaluations for any medical concerns. At your exam, the examiner reviews your answers and ensures claimed contentions are addressed in the exam report.

DD Form Report of Medical History – Military Forms – |

The assessment results are then accessible by both the DoD and VA. Medical history Medical concerns identified during your military career Current health status How It Works Schedule your exam at a military hospital or clinic or VA facility well in advance of your scheduled separation date.


Completed forms are covered by recruiting, medical evaluation board, and official military personnel file SORNs maintained by each of the Services. You can also access them by using the Blue Button. fom

The examiner must sign and date the second page. Questions 20 through 28 ask additional personal questions, which you must answer yes or no for each question. Close Window Loading, Please Wait! This may take a second or two.

Separation Health Assessment

You need only one exam. You must fill in the corresponding bubble for each medical issue.

Showing results 1 – 4 Page 1 of 1. First, fill out your basic information in boxes 1 through 4, providing your name, social security number, and contact information. Government sites or the information, products, or services contained therein. On the second page, provide your name and social security number at the top. This becomes part of your record. How do I file a VA disability claim?

The DD Form is now ready for submission to the Department of Defense for review of your medical history. Find one near you: A DD Form is formm Department of Defense form is used for gathering medical information for applicants to military service.

The primary collection of this information is from individuals seeking to join the Armed Forces.