Dd Form 2807-2 - Accessions Medical Prescreen Report Page 7
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7LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)
SOCIAL SECURITY NUMBER (Last 4)
SECTION VI - MEDICAL PROVIDER'S SUMMARY AND DESCRIPTION OF PERTINENT INFORMATION:
Review and comment on all medical records, electronically provided medical history information, and other electronic data available in the
Department of Defense Accessions Processing System. Medical providers may also develop any additional medical history deemed important and
record significant findings here or by interview and document them on DD Form 2808, "Report of Medical Examination".
Attach additional sheet(s) if necessary.
COMMENTS:
SECTION VII - MEDICAL PROVIDER'S PRESCREEN DETERMINATION BASED ON AVAILABLE INFORMATION:
b. MEDICAL PROCESSING STATUS
c. IF NOT WITHIN STANDARDS:
1.a. DATE
d. PROVIDER
(YYYYMMDD)
INITIALS
PA
PRW
PH
RJ
METR
PNJ
ICD
CONDITION
PULHES
SMWRA INPUT
KEY:
PA = Processing Authorized; PRW = Processing Requested by SMWRA; PH = Processing Hold; RJ = Return Justified; METR = Medical Evaluation and/or
Treatment Records; PNJ = Processing Not Justified; ICD = International Classification of Disease Code; PULHES = P (Physical Capacity), U (Upper
Extremities), L (Lower Extremities), H (Hearing), E (Eyes), S (Psychiatric); SMWRA = Service Medical Waiver Review Authority.
2. *FOR MEPS USE ONLY:
ON EXAM:
a. PSN COMP
b. PSN INCOM
c. NPS
d. *AE
e. *RE
f. *ME
g. *OE
h. DATE (YYYYMMDD)
i. PROVIDER INITIALS
KEY:
PSN = Prescreen; COMP = Complete; INCOM = Incomplete; NPS = Not Prescreened; AE = Applicant Error; RE = Recruiter Error; ME = MEPS Error; OE =
Other Source of Error.
3. AUTHORIZING MEDICAL PROVIDER
4. NUMBER OF
ADDITIONAL
a. NAME (Last, First, Middle Initial)
b. SIGNATURE
c. DATE SIGNED (YYYYMMDD)
SHEETS
SUBMITTED
DD FORM 2807-2, MAR 2015
Page 7 of 7 Pages
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