Pseudofolliculitis Barbae (Pfb) Shaving Waiver/evaluation/disposition

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Fillable Form
Supporting Directive BUPERSINST 1000.22B
PSEUDOFOLLICULITIS BARBAE (PFB) SHAVING WAIVER/EVALUATION/DISPOSITION
LAST NAME
FIRST NAME
M.I.
SSN
(LAST 4 DIGITS)
MEDICAL OFFICER INITIAL EVALUATION
No PFB or other medical condition that prevents shaving
Pseudofolliculitis Barbae (PFB)
Facial Nodulocystic Acne
Other:
NAME OF MEDICAL OFFICER/RANK
SIGNATURE/DATE
Due to the medical condition as specified above NO SHAVING of facial hair
is recommended on a temporary basis for:
SPECIFY PERIOD OF TIME
TITLE/SIGNATURE/DATE
MEDICAL OFFICER/SMDR DOCUMENTATION FOR PFB PROTOCOL COMPLETION:
PHASE I
SIGNATURE/TITLE/DATE
PHASE II
SIGNATURE/TITLE/DATE
PHASE III
SIGNATURE/TITLE/DATE
PHASE IV
SIGNATURE/TITLE/DATE
FAILURE OF PFB PROTOCOL RECOMMENDATION
This Navy service member has failed the established PFB protocol.
A
permanent "NO SHAVE" status is recommended.
SIGNATURE/TITLE
DATE
COMMANDING OFFICER DECISION
A permanent "NO SHAVING" status is authorized.
Refer to NAVPERSCOM (PERS-83) for Administrative
Separation
NAME/RANK/TITLE
SIGNATURE/DATE
NAVPERS 1000/1 (REV 12-02)
S/N: 0106-LF-982-8600
PREVIOUS EDITIONS WILL NOT BE USED
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FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE

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