Fillable Dd Form 2808 - Report Of Medical Examination

1. DATE OF EXAMINATION

2. SOCIAL SECURITY NUMBER

REPORT OF MEDICAL EXAMINATION

(YYYYMMDD)

PRIVACY ACT STATEMENT

AUTHORITY: 10 USC 504, 505, 507, 532, 978, 1201, 1202, and 4346; and E.O. 9397.

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): None.

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.

4. HOME ADDRESS (Street, Apartment Number, City, State and ZIP Code)

5. HOME TELEPHONE

3. LAST NAME - FIRST NAME - MIDDLE NAME

NUMBER

(SUFFIX)

(Include Area Code)

6. GRADE

7. DATE OF BIRTH

8. AGE

9. SEX

10.a. RACIAL CATEGORY (X one or more)

b. ETHNIC CATEGORY

(YYYYMMDD)

American Indian or

Black or African

Native Hawaiian or

Hispanic/Latino

Female

Alaska Native

American

Other Pacific Islander

Not Hispanic/

Male

Asian

White

Latino

11. TOTAL YEARS GOVERNMENT

12. AGENCY (Non-Service Members Only)

13. ORGANIZATION UNIT AND UIC/CODE

SERVICE

b. CIVILIAN

a. MILITARY

14.a. RATING OR SPECIALTY (Aviators Only)

b. TOTAL FLYING TIME

c. LAST SIX MONTHS

16. NAME OF EXAMINING LOCATION, AND ADDRESS

15.a. SERVICE

b. COMPONENT

c. PURPOSE OF EXAMINATION

(Include ZIP Code)

Coast

Army

Enlistment

Medical Board

Other

Active Duty

Guard

Navy

Commission

Retirement

Reserve

Marine Corps

Retention

U.S. Service Academy

National Guard

Air Force

Separation

ROTC Scholarship Program

CLINICAL EVALUATION

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

Nor-

Ab-

44. NOTES: (Describe every abnormality in detail. Enter pertinent item

mal

norm

number before each comment. Continue in item 73 and use additional

17. Head, face, neck, and scalp

sheets if necessary.)

18. Nose

19. Sinuses

20. Mouth and throat

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

22. Drums (Perforation)

23. Eyes - General (Visual acuity and refraction under items 61 - 63)

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 (See Item 35 Continued)

36. Spine, other musculoskeletal

37. Identifying body marks, scars, tattoos

38. Skin, lymphatics

39. Neurologic

40. Psychiatric (Specify any personality deviation)

41. Pelvic (Females only)

35. FEET (Continued) (Circle category)

42. Endocrine

43. DENTAL DEFECTS AND DISEASE

(Please explain. Use dental form if completed

Normal Arch

Mild

Asymptomatic

by dentist. If dental examination not done by

Moderate

Acceptable

Pes Cavus

dental officer, explain in Item 44.)

Symptomatic

Not Acceptable

Class

Pes Planus

Severe

DD FORM 2808, OCT 2005

Page 1 of 3 Pages

DoD exception to SF 88 approved by ICMR, August 3, 2000.

PREVIOUS EDITION IS OBSOLETE.

Adobe Professional

Dd Form 2808 - Report Of Medical Examination - 2005

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