Dd Form 2807-1 - Defense Technical Information Center Page 3
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3LAST NAME, FIRST NAME, MIDDLE NAME (SUFFIX)
SOCIAL SECURITY NUMBER
30. EXAMINER'S SUMMARY AND ELABORATION OF ALL PERTINENT DATA (Physician/practitioner shall comment on all positive answers in
questions 10 - 29. Physician/practitioner may develop by interview any additional medical history deemed important, and record any
significant findings here.)
a. COMMENTS
d. DATE SIGNED
b. TYPED OR PRINTED NAME OF EXAMINER (Last, First, Middle Initial)
c. SIGNATURE
(YYYYMMDD)
DD FORM 2807-1, MAR 2015
Page 3 of 3 Pages
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