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DoD ID NUMBER 13a. PRINTED/TYPED NAME DA FORM 7349 MAY 2014 10. RANK/GRADE 11. MOS 12. DATE 13b. SIGNATURE PREVIOUS EDITIONS ARE OBSOLETE Page 1 of 2 APD LC v1.00ES 14. INITIAL MEDICAL REVIEW - ANNUAL MEDICAL CERTIFICATE For use of this form see AR 40-501 the proponent agency is OTSG DATA REQUIRED BY THE PRIVACY ACT OF 1974 Authority Section 133 Title 10 United States Code 10 USC 133. Purpose The primary use of this information is to provide medical information of sufficient detail to ensure...
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How to fill out da 7349 form
How to fill out DA Form 7349:
01
Start by obtaining a blank copy of DA Form 7349, which can usually be found on the official website of the U.S. Army or obtained from your unit's administrative office.
02
Fill in the personal information section of the form, including your name, rank, social security number, and contact information.
03
Provide details about the training or event you are requesting leave or pass for. This includes the dates, type of training/event, and the location.
04
Indicate the type of leave or pass you are requesting, such as regular leave, emergency leave, or pass.
05
If applicable, provide information about any dependents who will be accompanying you during your leave or pass, including their names, ages, and relationship to you.
06
Complete the financial information section, which includes details about your travel expenses, such as transportation, lodging, and meals.
07
Sign and date the form in the appropriate sections.
08
Submit the completed DA Form 7349 to your unit's administrative office for processing.
Who needs DA Form 7349:
01
Active duty Army personnel who are requesting leave or a pass for a training, event, or personal reasons.
02
Reservists and National Guard members who are requesting leave or a pass for an authorized training or event.
03
Army civilian employees who are requesting leave or a pass for personal reasons or an approved training or event.
Please note that DA Form 7349 may have specific requirements or variations depending on the unit or command, so it is important to consult with your unit's administrative office for any additional instructions or guidance.
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What is da form 7349?
DA Form 7349 is a United States Army form titled "Initial Medical Review – Annual Medical Certificate." It is used to assess and certify the medical fitness of an individual for a variety of purposes, including participation in physical fitness training, certain job assignments, deployments, or other activities within the Army. The form collects information about the individual's medical history, current health conditions, and potential limitations that might affect their ability to perform specific tasks. It is typically completed by the individual and reviewed by a medical professional.
Who is required to file da form 7349?
DA Form 7349, also known as a Initial Medical Review - Annual Medical Certificate, is typically filed by military personnel. This form is used to ensure that individuals are medically fit for specific duties, such as certain types of military training or deployments. It is often required for soldiers, reservists, and other members of the military.
How to fill out da form 7349?
To fill out DA Form 7349 (Initial Medical Review – Annual Medical Certificate), follow these steps:
1. Write the date in the top right corner of the form.
2. In Section I: Personal Information, enter your full name, social security number, date of birth, rank, and unit.
3. In Section II: Provider Use, leave this section blank for now. This section will be completed by a healthcare provider during a medical examination.
4. In Section III: Medical Exam, you should leave this section blank for now. A healthcare provider will complete this section during the medical examination.
5. In Section IV: Provider’s Statement, this section should also be left blank for now. A healthcare provider will complete this section during the medical examination.
6. In Section V: Soldier’s Statement, check the appropriate box to indicate if you have any of the listed medical conditions. If you have any other medical condition that is not listed, write it in the provided space.
7. In Section VI: Malaria Prophylaxis, check the appropriate box to indicate your awareness and compliance with malaria prophylaxis measures.
8. In Section VII: General Medical History, check yes or no for each question to indicate whether you have any history of the listed medical conditions. If you have any other medical condition that is not listed, write it in the provided space.
9. In Section VIII: Medication History, list all current medications you are taking. Include the name of the medication, dose, and frequency of administration.
10. In Section IX: Other Health Information, provide any additional relevant health information that may affect your medical status. For example, if you have had recent surgeries or illnesses, list them here.
11. In Section X: Soldier’s Certification and Signature, sign and date the form.
12. In Section XI: Provider’s Certification and Signature, leave this section blank for now. A healthcare provider will complete this section during the medical examination.
Note: The form should be completed truthfully and accurately to ensure an accurate assessment of your medical status.
After completing the form, it should be submitted to the appropriate healthcare provider who will review your medical history, conduct the required medical examination, and complete the remaining sections of the form.
What is the purpose of da form 7349?
The purpose of DA Form 7349, also known as the Initial Medical Review - Soldier Taking Prescription Medication(s), is to ensure that soldiers who are prescribed medication are medically fit for duty and to document any potential risks or limitations associated with the medication. This form is used to create an initial assessment of the soldier's ability to perform their duties safely while taking prescription medications. It provides important information to medical personnel, commanders, and other relevant parties in making informed decisions regarding the soldier's medical fitness for duty.
What information must be reported on da form 7349?
DA Form 7349, also known as the Initial Medical Review - Annual Respirator Medical Clearance, is a form used by the U.S. Army to determine an individual's medical fitness to wear a respirator. The information that must be reported on this form includes:
1. Personal Information: Full name, rank, date of birth, social security number, gender, and contact information (address, phone number, email).
2. Unit Information: Unit name, organization, address, and phone number.
3. Identification and Respirator Type: Information about the type of respirator for which the individual is seeking clearance, including the protection factor, make and model, and National Stock Number (NSN).
4. Medical History: Detailed information about the individual's medical history, including any respiratory illnesses, lung diseases, heart conditions, allergies, surgeries, medications, or other relevant medical conditions.
5. Occupational History: Details about the individual's current and past occupational exposure to respiratory hazards, such as dust, chemicals, smoke, or other airborne contaminants.
6. Physical Examination: The results of a physical examination conducted by a healthcare provider, including vital signs (height, weight, blood pressure, pulse), general medical assessment, lung function testing, and any other relevant findings.
7. Medical Evaluation: A summary and evaluation of the individual's medical fitness to wear a respirator, including any restrictions or limitations related to their respiratory health.
8. Healthcare Provider's Signature: The signature and contact information of the healthcare provider who conducted the examination and reviewed the individual's medical history.
It is essential to note that this information may vary depending on the specific requirements and guidelines of the Army unit or organization. It is important to consult the latest version of the DA Form 7349 and any associated regulations or instructions for the most accurate and up-to-date information.
What is the penalty for the late filing of da form 7349?
As of my knowledge, there is no specific penalty mentioned for the late filing of DA Form 7349 (Initial Medical Review - Annual Medical Certificate). However, it is always advisable to submit required forms or documents within the specified timeframe to ensure compliance with regulations and to avoid any potential issues or consequences that may arise due to the late submission.
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