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REPORT OF MEDICAL EXAMINATION Prescribed by: DoDI 1304.2

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Page 1 of 4
Prescribed by: DoDI 1304.2
DD FORM 2808, July 2019
REPORT OF MEDICAL EXAMINATION
1. DATE OF EXAMINATION
(YYYYMMDD)
2a. SOCIAL SECURITY NUMBER
2b. DoD ID NUMBER
(If applicable)
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 504, Persons not qualified; 10 U.S.C. 505, Regular components: qualifications, term, grade; 10 U.S.C. 507, Extension of enlistment for members
needing medical care or hospitalization; 10 U.S.C. 532, Qualifications for original appointment as a commissioned officer; 10 U.S.C. 978, Drug and alcohol abuse and dependency:
testing of new entrants; 10 U.S.C. 1201, Regulars and members on active duty for more than 30 days: retirement; 10 U.S.C. 1202, Regulars and members on active duty for more than
30 days: temporary disability retired list; 10 U.S.C. 4346, Cadets: requirements for admission; DoD Directive 1145.2, United States Military Entrance Processing Command; E.O. 9397
(SSN) and 10 U.S.C. 1204, Members on Active Duty for 30 Days or Less or on Inactive Duty Training: Retirement, as amended.
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): The Routine Uses are listed in the applicable system of records notice found at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/
Article/570661/a0601-270-usmepcom-dod/
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.
3. LAST NAME - FIRST NAME - MIDDLE NAME
(Suffix)
4. HOME ADDRESS (Street, Apartment Number, City,
State and Zip Code)
5a. HOME TELEPHONE
NUMBER (Include Area Code)
5b. E-MAIL ADDRESS
6. GRADE/
RANK
7. DATE OF BIRTH
(YYYYMMDD)
8. AGE
9a. BIRTH SEX
Male
Female
9b. PREFERRED GENDER
Male
Female
10a. ETHNIC CATEGORY
Hispanic/Latino
Non Hispanic/Latino
10b. RACIAL CATEGORY (Select one)
American Indian or Alaska Native Asian
Black or African American White
Native Hawaiian or Other Pacific Islander
11. TOTAL YEARS GOVERNMENT SERVICE
a. MILITARY b. CIVILIAN
12. AGENCY (Non-Service Members Only) 13. ORGANIZATION UNIT AND UIC/CODE
14a. RATING OR SPECIALTY (Aviators Only) 14b. TOTAL FLYING TIME 14c. LAST SIX MONTHS
15a. SERVICE
Army
Air Force
Marine Corps
Navy
Coast Guard
15b. COMPONENT
Active Duty
Reserve
National Guard
15c. PURPOSE OF EXAMINATION
Enlistment Retirement
Commission U.S. Service Academy
Retention ROTC Scholarship Program
Separation Medical Board
Other
16. NAME OF EXAMINING LOCATION, AND ADDRESS
(Include Zip Code)
MEDICAL EVALUATION (Check each item in appropriate column. Enter "NE" if not evaluated.)
Normal
Abnormal
NE
17. Head, face, neck and scalp
18. Nose
19. Sinuses
20. Mouth and throat
21. Ears - General (Int. and ext. canals/Auditory acuity under item 71)
22. Tympanic Membranes (Perforation)
23. Eyes - General
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 (Check category)
35a. Normal Arch Pes Planus Pes Cavus
35b. Mild Moderate Severe
35c. Asymptomatic Symptomatic Rigid
36. Spine, other musculoskeletal
37. Body marks, scars, tattoos
38. Skin, lymphatics
39. Neurologic
40. Psychiatric (Specify any personality disorder)
41. Pelvic (Females only)
42. Endocrine
43. DENTAL DEFECTS AND DISEASE
(Please explain. Use dental form if
completed by dentist. If abnormality noted,
explain in item 44.)
Acceptable
Not Acceptable
Class
44. NOTES: (Mandatory comment for every abnormality identified
in items 17 - 43. Enter pertinent item number before each comment.
Continue comments or use drawings in item 89 and use additional
sheets if necessary.)
Page 2 of 4
Prescribed by: DoDI 1304.2
DD FORM 2808, July 2019
LAST NAME - FIRST NAME - MIDDLE NAME (Suffix) SOCIAL SECURITY NUMBER DoD ID NUMBER
LABORATORY FINDINGS
45. URINALYSIS a. Albumin b. Sugar 46. URINE HCG 47. H/H 48. BLOOD TYPE
TESTS RESULTS
49. HIV
50. DRUGS
51. ALCOHOL
52. OTHER
a. PAP SMEAR
b. EKG
c. CXR
HIV SPECIMEN ID LABEL DRUG TEST SPECIMEN ID LABEL
MEASUREMENTS AND OTHER FINDINGS
53. HEIGHT (in.)
54. WEIGHT (lbs.)
55a. MIN WGT 55b. MAX WGT 55c. MAX BF % 55d. BMI 56. TEMPERATURE 57. HEART RATE
58. BLOOD PRESSURE
a. 1ST b. 2ND c. 3RD
SYS. SYS. SYS.
DIAS. DIAS. DIAS.
59. RED/GREEN
60. OTHER VISION TEST
61. DISTANCE VISION
Right Uncorr.
20/
Corr. to 20/
Left Uncorr.
20/
Corr. to 20/
62. REFRACTION AUTO MANIFEST CYCLO
Sph: Cyl: Axis:
Sph: Cyl: Axis:
63. NEAR VISION
Right Uncorr.
20/
Corr. to 20/ Add:
Left Uncorr.
20/
Corr. to 20/ Add:
64. HETEROPHORIA
ES EX R.H. L.H.
Prism
div.
Prism
Conv CT
NPR PD
65. ACCOMMODATION
Right Left
66. COLOR VISION (Pass/Fail and Score)
PIP
RED/
GREEN
Color
Dx
67. DEPTH PERCEPTION (Pass/Fail and Score)
AFVT
RANDOT/
MCST
68. FIELD OF VISION
69. NIGHT VISION
70. INTRAOCULAR PRESSURE
O.D. O.S.
71a. AUDIOMETER Unit Serial Number
Date Calibrated (YYYYMMDD)
HZ 500 1000 2000 3000 4000 6000
Left
Right
71b. Unit Serial Number
Date Calibrated (YYYYMMDD)
HZ 500 1000 2000 3000 4000 6000
Left
Right
72a. READING
ALOUD TEST:
SAT UNSAT
72b.
VALSALVA:
SAT UNSAT
72c. OTHER TESTING
73. NOTES AND/OR INTERVAL HISTORY
Page 3 of 4
Prescribed by: DoDI 1304.2
DD FORM 2808, July 2019
LAST NAME - FIRST NAME - MIDDLE NAME (Suffix) SOCIAL SECURITY NUMBER DoD ID NUMBER
74. EXAMINEE
IS MEDICALLY QUALIFIED
IS NOT MEDICALLY QUALIFIED
75. I have been advised of my disqualifying condition(s).
75a. SIGNATURE OF EXAMINEE 75b. DATE (YYYYMMDD)
76. PHYSICAL PROFILE
P U L H E S X D PROFILER INITIALS DATE (YYYYMMDD)
77. SIGNIFICANT OR DISQUALIFYING MEDICAL DIAGNOSES
ITEM
NO.
MEDICAL DIAGNOSIS ICD CODE PROFILE SERIAL
RBJ DATE
(YYYYMMDD)
QUALIFIED DISQUALIFIED EXAMINER INITIALS
WAIVER RECEIVED
SERVICE DATE (YYYYMMDD)
78. SUMMARY OF MEDICAL DIAGNOSES (List diagnoses with item numbers) (Use additional sheets if necessary).
79. RECOMMENDATIONS (Specify) (Use additional sheets if necessary).
80. MEPS WORKLOAD (For MEPS use only)
WKID ST
DATE (YYYYMMDD)
INITIALS WKID ST
DATE (YYYYMMDD)
INITIALS
81. MEDICAL INSPECTION DATE HT WT %BF MAX WT HCG QUAL DISQ EXAMINER'S NAME AND SIGNATURE
82a. TYPED OR PRINTED NAME OF PHYSICIAN OR EXAMINER
82b. Signature
83a. TYPED OR PRINTED NAME OF PHYSICIAN OR EXAMINER
83b. Signature
84a. TYPED OR PRINTED NAME OF DENTIST OR PHYSICIAN (Indicate which)
84b. Signature
85a. TYPED OR PRINTED NAME OF REVIEWING OFFICER/APPROVING AUTHORITY
(Indicate which)
85b. Signature
86. This examination has been administratively reviewed for completeness and accuracy.
a. SIGNATURE b. GRADE c. DATE (YYYYMMDD)
87. WAIVER GRANTED (If yes, date and by whom)
YES NO
88. NUMBER OF
ATTACHED SHEETS
Page 4 of 4
Prescribed by: DoDI 1304.2
DD FORM 2808, July 2019
89. ADDITIONAL REMARKS
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REPORT OF MEDICAL EXAMINATION Prescribed by: DoDI 1304.2

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Completed 22 January 2021

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