Fillable form must be completed by the applicant with (NAVSUP - Naval Supply Systems Command)

Fill Online, Printable, Fillable, Blank form must be completed by the applicant with (NAVSUP - Naval Supply Systems Command) Form

Use Fill to complete blank online NAVSUP - NAVAL SUPPLY SYSTEMS COMMAND pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

form must be completed by the applicant with (NAVSUP - Naval Supply Systems Command)

On average this form takes 120 minutes to complete

The form must be completed by the applicant with (NAVSUP - Naval Supply Systems Command) form is 7 pages long and contains:

  • 4 signatures
  • 0 check-boxes
  • 464 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your NAVSUP - Naval Supply Systems Command forms online.

BROWSE NAVSUP - NAVAL SUPPLY SYSTEMS COMMAND FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
INSTRUCTIONS FOR COMPLETING DD FORM 2807-2,
ACCESSIONS MEDICAL PRESCREEN REPORT
1. This form is to be completed by each individual who requires medical processing in accordance with Department of Defense Instruction (DODI)
6130.03, “Physical Standards for Appointment, Enlistment, or Induction” and DODI 1304.02, “Accession Processing Data Collection Forms.” This
form must be completed by the applicant with the assistance of the recruiter, parent(s), or guardian, as needed.
6. MEPS Chief Medical Officers (CMOs) may locally modify the above instructions and instruct recruiters on what supporting medical documents they
require to complete the DD Form 2807-2 medical prescreen review, if doing so enhances the efficiency of medical processing and is consistent with
DODI 6130.03 and USMEPCOM guidance.
7. If all attempts to obtain required substantiating and supporting medical documents fail, the recruiter must contact the MEPS medical department for
guidance prior to submitting an incomplete medical prescreen packet.
2. Replaces the existing medical prescreen form (DD Form 2807-2, AUG 2011). Additional questions have been added to improve its usefulness to the
accessions medical pre-screening process. The questions are intended to provide the U.S. Military Entrance Processing Command (USMEPCOM) with
health history information necessary to identify conditions commonly related to medical causes for separation during basic and follow-on training (per
P.L. 105-85, Div. A, Title V, S 532).
3. Use of medical history information facilitates efficient, timely, and accurate medical processing of individuals applying for Service in the United
States Armed Forces or United States Coast Guard. Positive responses do not automatically result in disqualification but are necessary to prompt further
explanation that will be used to determine medical qualification. Medical history information assists USMEPCOM medical personnel in the medical
prescreening of applicants. Accurate responses to all questions are critical and all positive responses must be fully explained. Applicant responses to
questions may be verified using electronically obtained medical history by the USMEPCOM. Medical history information will be used by the
Department of Defense for continuity of care purposes if and when an applicant accesses into the Armed Forces or Coast Guard. Supporting medical
information in the form of historical medical records may also be attached to the Service member’s medical record. Medical history information
collected by the USMEPCOM during accession medical processing will serve as the foundation for a Service member’s lifecycle medical treatment
record.
4. The completed DD Form 2807-2 along with all substantiating and supporting medical documents must be delivered to USMEPCOM for review prior
to scheduling the applicant for medical examination. All documents must be submitted for review in accordance with standards below. After review, the
Military Entrance Processing Station (MEPS) will notify the Recruiting Service of the applicant’s status.
- 1 processing day prior for applicants with no positive medical history (all items marked “NO” with the exception of items 9 (glasses/contacts), 11
(defective color vision), and 20 (braces) which can be “YES”).
- 2 processing days prior; for applicants with ANY positive medical history (other than those noted above) and 5 OR LESS single-sided pages of
supporting medical documents.
- 3 processing days prior; for applicants with ANY positive medical history (other than those noted above) and MORE THAN 5 single-sided pages of
supporting medical documents.
Secure electronic submission is preferable; if not feasible bring/mail to the nearest MEPS which can be found at http://www.mepcom.army.mil/
battalions/index.html. All supporting medical documentation must be present with the DD Form 2807-2 to meet the above timeframes for review. After
review by a USMEPCOM provider, appropriate processing notification will be made.
5. If an applicant has been seen by any Health Care Provider (HCP) and/or has been hospitalized for any reason, medical records/documentation must be
obtained and submitted along with a medical release to USMEPCOM. Provide all medical documents via secure electronic submission (if possible) to
the nearest MEPS. If hand-carried or mailed, ensure they are sealed in an envelope marked: “CONFIDENTIAL: MEPS MEDICAL DEPARTMENT".
a. If the applicant was evaluated and/or treated on an out-patient basis, obtain a copy of actual treatment records of the private medical doctor/HCP
including:
(1) office or clinic assessment and progress notes, including the initial assessment documents, subsequent evaluation and treatment documents, and
record of date when released from care to full, unrestricted activity;
(2) emergency room (ER) report(s);
(3) study reports (e.g. x-ray, magnetic resonance imaging (MRI), Computerized Tomography (CT), etc.);
(4) procedure reports (e.g., arthroscopy, electroencephalogram (EEG; brain wave test), echocardiogram (ultrasound of the heart), etc.);
(5) pathology reports (e.g., tissue specimens sent to lab for microscopic diagnosis, abnormal PAP smear cytology, etc.);
(6) specialty consultation records (e.g., neurologist, cardiologist, OB/GYN, gastroenterologist, orthopedic surgeon, pulmonologist, allergist, etc.).
b. If the applicant was hospitalized, obtain a copy of the inpatient hospital record, to include (if any): ER report, admission history and physical,
study reports, procedure reports, operative report (example: surgery to bone or joint), pathology report, specialty consultation reports, and discharge
summary.
c. If an applicant has been diagnosed or treated for any attention disorder (Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity
Disorder (ADHD), etc.), academic skills or perceptual defect, or had an Individualized Education Plan or 504 Plan, call/contact the MEPS medical
department for additional instructions.
d. Obtain any and all documents relating to any evaluation, treatment or consultation with a psychiatrist, psychologist counselor, or therapist, on an
inpatient or out-patient basis for any reason, including but not limited to counseling or treatment for adjustment or mood disorder, family or marriage
problems, depression, treatment or rehabilitation for alcohol, drug, or substance abuse.
DD FORM 2807-2, MAR 2015
PREVIOUS EDITION IS OBSOLETE.
Page 1 of 7 Pages
Adobe Designer 9.0
ACCESSIONS MEDICAL PRESCREEN REPORT
OMB No. 0704-0413
OMB approval expires
Oct 31, 2017
The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, Alexandria, VA 22350-3100
(0704-0413). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a
currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 504, 505, 507, 532, 978, 1201, 1202, and 4346; and E.O. 9397 (SSN).
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): DoD Blanket Routine Uses found at http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx apply to the use of this
data.
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.
WARNING: The information you have given constitutes an official statement. Federal law provides severe penalties (up to 5 years confinement or $10,000
fine, or both), to anyone making a false statement. If you are selected for enlistment, commission or entrance into a commissioning program based on a
false statement, you may be subject to prosecution under the Uniform Code of Military Justice or to administrative separation proceedings for discharge, and
could receive a less than honorable discharge.”
4. SOCIAL SECURITY NUMBER
3. DATE OF BIRTH (YYYYMMDD)
1. LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)
5. HEIGHT (inches) 9. DATE (YYYYMMDD)
12. USUAL OCCUPATION
8. SERVICE AND COMPONENT (X as applicable)
10. PURPOSE OF EXAMINATION (X as applicable)
11. POSITION (If a current Federal Employee)
(Job Title, Grade, Component)
7. MAX WEIGHT
(lbs.)
6. WEIGHT (lbs.)
2. AGE
SECTION I - APPLICANT
SECTION II - MEDICAL HISTORY. Initial each item "Yes" or "No". All "Yes" items must be fully explained in Section III (Pages 4 and 5).
Navy
Army
USAF
Enlistment U.S. Service Academy
ROTC Scholarship
Other (Specify)
Commission
Retention
1. Double vision
8. Any other eye condition, injury or surgery
10. Loss of vision in either eye
11. Color vision deficiency or color blindness
7. Strabismus or "lazy eye" or any surgery to correct these
6. Glaucoma
5. Night blindness
4. Eye surgery to improve vision (RK, PRK, LASIK, etc.)
3. Cataracts or surgery for cataracts
2. Detached retina or surgery to repair a detached retina
USCG
Other:
USMC
National Guard
Reserve Component
Regular
CURRENTLY HAVE OR ANY HISTORY OF:
EYES
22. Asthma
27. Used inhaler(s) or steroids for breathing problem(s)
30. History of chest, chest wall, or breast surgery
29. Collapsed lung or other lung condition
28. Chronic cough or frequent coughing at night
26. Other breathing problems worsened by exercise, weather,
pollens, etc.
25. Bronchitis
24. Shortness of breath
23. Wheezing
LUNGS, CHEST WALL, PLEURA, AND MEDIASTINUM
21. Tooth or gum problems (other than cavities)
12. Perforated ear drum or tubes in ear drum(s)
14. Loss of balance or vertigo
13. Ear surgery, to include mastoidectomy or repair of perforated
ear drum
EARS
31. Heart murmur, valve problem or mitral valve prolapse
36. Any other heart problems
35. An abnormal electrocardiogram (EKG)
34. Pain or pressure in the chest
33. Heart surgery
32. Palpitation, pounding heart or abnormal heartbeat
HEART
37. Stomach, esophageal or intestinal ulcer
45. Rectal disease, hemorrhoids, or blood from the rectum
47. Bariatric surgery (weight loss surgery)
46. Hemorrhoid surgery
42. Rupture/hernia
44. Chronic or recurrent intestinal problem of the small or large
bowel such as Irritable Bowel Syndrome, Crohn's disease,
Ulcerative Colitis, or Celiac disease
43. Surgery to remove or repair a portion of the intestine or spleen
(other than the appendix)
41. Jaundice (except neonatal) or hepatitis (liver disease)
40. Gall bladder trouble or gallstones
39. Frequent indigestion or heartburn
38. Difficulty swallowing
ABDOMINAL ORGANS AND GASTROINTESTINAL SYSTEM
15. Hearing loss or wear a hearing aid
HEARING
16. Ear, nose, or throat trouble including tonsillectomy
19. Any surgery of your face, mandible or jaw
18. Absence of, or disturbance of sense of smell
17. Chronic sinus infections or recurrent nose bleeds
NOSE, SINUSES, MOUTH, AND LARYNX
9. Worn/wear contact lenses or glasses (Bring your contact lens kit
and solution so you can remove contacts during vision testing, or
for best results remove 72 hours prior. Bring your eyeglasses no
matter how old they are.)
VISION
20. Do you wear dental braces or plan to wear braces? (If so, your
orthodontist must submit a letter stating that active orthodontic
treatment will be completed prior to active duty date: release form/
sample format can be found in the Recruiter's Medical Guide.)
DENTAL
NOYES
CURRENTLY HAVE OR ANY HISTORY OF:
YES NO
Page 2 of 7 Pages
DD FORM 2807-2, MAR 2015
✖
NROTC
New Student Indoctrination
✖
N/A
N/A
SOCIAL SECURITY NUMBER (Last 4)
LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)
SECTION II - MEDICAL HISTORY (Continued). Initial each item "Yes" or "No". All "Yes" items must be fully explained in Section III.
48. A change of menstrual pattern (other than pregnancy)
50. Any abnormal PAP smear(s)
52. Diagnosed with endometriosis or ovarian cysts
54. Sexually transmitted disease (syphilis, gonorrhea, chlamydia,
genital warts, herpes, etc.)
59. Sexually transmitted disease (syphilis, gonorrhea, chlamydia,
genital warts, herpes, etc.)
53. Evaluation, treatment or surgery for any other gynecological
(female) disorder
51. Date of last PAP smear (YYYYMMDD)
55. First day of last menstrual period (YYYYMMDD)
49. Pregnancy, abortion or miscarriage
CURRENTLY HAVE OR ANY HISTORY OF:
FEMALES ONLY:
56. Missing a testicle, testicular implant, or undescended testicle
58. Prostate problems
57. Variocele, hydrocele, or any scrotal mass, swelling or pain
MALES ONLY:
60. Missing a kidney
65. Bedwetting or treatment for bedwetting (after childhood)
66. Hernia
64. Painful or difficult urination
63. Blood or protein in urine
62. Kidney or urinary tract surgery of any kind
61. Kidney stone, infection or disease
URINARY SYSTEM
ENDOCRINE AND METABOLIC
67. Recurrent back pain or back problem
71. Abnormal curvature of your spine (any part)
70. Back or neck surgery
69. Recurrent neck pain
68. Herniated disk
SPINE AND SACROILIAC JOINTS
72. Painful shoulder, elbow, wrist, hand or fingers
73. Dislocated shoulder, elbow, wrist, hand or fingers
UPPER EXTREMITIES
78. Bone, joint, or other orthopedic deformity
79. Loss of finger or toe, or extra finger or toe
87. Any need to use corrective devices such as prosthetic devices,
knee brace(s), back support(s), lifts or orthotics
88. Any other orthopedic, muscle, or sports injury problems
86. Pain or swelling at the site of an old fracture
85. Plate(s), screw(s), rod(s) or pin(s) in any bone
84. Surgery on any joint/bone (including arthroscopy)
83. Any swollen joint(s)
82. Arthritis, rheumatism, or bursitis
81. Impaired use of arms, hands, legs, or feet (any reason)
80. Loss of the ability to fully flex (bend) or fully extend a finger, toe,
or other joint
MISCELLANEOUS CONDITIONS OF THE EXTREMITIES
LEARNING, PSYCHIATRIC, AND BEHAVIORAL
131. Evaluated or treated for Attention Deficit Disorder (ADD) or
Attention Deficit Hyperactivity Disorder (ADHD)
133. Diagnosed with a learning disorder, to include dyslexia
135. Seen a psychiatrist, psychologist, social worker, counselor or
other professional for any reason (inpatient or out-patient)
including counseling or treatment for school, adjustment, family,
marriage, divorce, depression, anxiety, or treatment of alcohol,
drug or substance abuse (Applicant or recruiter will request
sealed medical supporting documents from health care pro-
viders marked "CONFIDENTIAL: MEPS MEDICAL DEPART-
MENT" and submit directly to MEPS medical personnel.)
134. Received counseling of any type
132. Taken (or taking) medication, drugs, or any substance to
improve attention, behavior, or physical performance
SLEEP DISORDERS
89. High or low blood pressure
90. Raynaud's phenomenon or disease
92. Pulmonary embolism (blood clot in lung)
91. Deep Vein Thrombosis (blood clot; leg or elsewhere)
VASCULAR
74. Foot trouble (e.g., pain, corns, bunions, warts, ingrown toenails,
etc.)
75. Knee trouble (e.g., locking, giving out, or ligament injury, etc.)
77. Dislocated hip, knee, ankle, foot or toes
76. Painful hip, knee, ankle, foot or toes
LOWER EXTREMITIES
93. Acne or psoriasis
96. Large or painful scars
97. Any other skin problems
95. Atopic dermatitis
94. Eczema
SKIN AND CELLULAR
98. Anemia
99. Blood clots requiring blood thinner medicine
101. Prolonged bleeding (after an injury or tooth extraction)
102. Any other blood or circulation problems
100. Absence or removal of the spleen
BLOOD AND BLOOD FORMING TISSUES
103. Adverse reaction to medication (describe reaction in Section III)
105. Allergy to common foods (milk, eggs, fish, meat, etc.)
111. Car, train, sea, or air sickness
110. Disorder(s) of your immune system (including HIV)
109. Malaria
114. Diabetes or told that you should be tested for diabetes
113. High or low blood sugar
112. Thyroid trouble or goiter
NEUROLOGIC
117. Taking medication to prevent headaches
116. Frequent or severe headaches, including migraines
115. Cerebrovascular incident (stroke)
126. Dizziness or fainting spells
127. Any other neurologic problems
125. Seizures, convulsions, epilepsy or fits
124. Meningitis, encephalitis, or other neurological problems
130. Sleep apnea or severe snoring
129. Frequent trouble sleeping
128. Sleepwalking or narcolepsy
123. Paralysis
122. Loss of memory or amnesia, or neurological symptoms
121. A period of unconsciousness or concussion
120. A head injury, memory loss, or amnesia
119. A skull fracture
118. Lost time from work or school due to frequent or severe
headaches
108. Positive test for tuberculosis (PPD or blood test)
107. Tuberculosis or lived with someone who had tuberculosis
106. Allergy to wool, latex, or other material
104. Adverse reaction to serum, insect stings, or tree nuts
SYSTEMIC
NOYES
CURRENTLY HAVE OR ANY HISTORY OF:
YES NO
Page 3 of 7 Pages
DD FORM 2807-2, MAR 2015
SOCIAL SECURITY NUMBER (Last 4)
LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)
SECTION II - MEDICAL HISTORY (Continued). Initial each item "Yes" or "No". All "Yes" items must be fully explained in Section III.
SECTION III - APPLICANT COMMENTS. Explain all "Yes" answers to questions 1 - 164 above.
Begin with the Item Number. Describe answer(s) fully: provide date(s) of problem(s)/condition(s); provide names of Health Care Providers (HCPs),
Clinic(s) and/or Hospital(s) along with the City and State; explain what was done (e.g., evaluation and/or treatment); and describe your current
medical status. Attach additional sheet(s) if necessary and sign and date each additional page. Obtain and attach copies of applicable medical
evaluation and treatment records.
CURRENTLY HAVE OR ANY HISTORY OF:
NOYES
CURRENTLY HAVE OR ANY HISTORY OF:
YES NO
LEARNING, PSYCHIATRIC, AND BEHAVIORAL (Continued)
141. Anorexia, bulimia, or other eating disorder
145. Used illegal drugs or abused prescription drugs
146. Have you been evaluated, treated, or hospitalized for substance
abuse, addiction or dependence (including illegal drugs,
prescription medications or other substances)
147. Have you been evaluated, treated, or hospitalized for alcohol
abuse, dependence, or addiction
149. Any other learning, psychiatric, or behavioral problems
148. Post-traumatic Stress Disorder or excessive stress requiring
counseling and/or medication following a traumatic experience
144. Have you ever attempted or considered suicide
143. Have you ever purposely cut or harmed yourself
142. Habitual stammering or stuttering
150. Tumor, growth, cyst, or cancer of any type
TUMORS AND MALIGNANCIES
151. Cold injury, frostbite or cold intolerance
152. Heat injury, heat stroke or heat intolerance
MISCELLANEOUS
153. Are you taking any medications, to include over the counter
medications (OTCs), vitamin, herbal, or nutritional supplements
(If "yes", list all in Section III.)
154. Any recent unexplained gain or loss of weight
155. Artificial or replacement body part (eye, bone, palate, hip, knee,
joint, leg, arm, etc.)
156. Have you ever had any illness or injury other than those already
noted? (If "yes", specify when, where and give details in
Section III.)
SUPPLEMENTAL QUESTIONS
157. Have you ever been treated in an Emergency Room? (If "yes",
explain in Section III.)
160. Have you ever been rejected for military Service for any
reason? (If "yes", give date and reason in Section III.)
161. Have you ever been discharged from the military Service for
any reason? (If "yes", give date, reason, and type of discharge,
whether honorable, other than honorable, for unfitness or
unsuitability in Section III.)
162. Have you ever been refused employment or been unable to
hold a job or stay in school because of any of the following:
(If "yes", answer a - d below and give reasons in Section III.)
163. Applied for and/or received disability evaluation and/or
compensation for an injury or other medical conditions
(If "yes", provide details in Section III.)
164. Have you ever been denied life insurance? (If "yes", provide
reason(s) in Section III.)
a. Sensitivity to chemicals, dust, sunlight, etc.
d. Other medical reasons
c. Inability to stand, sit, kneel, lie down, etc.
b. Inability to perform certain motions
159. Have you ever had, or have you been advised to have any
operations or surgery? (If "yes", describe and give age at which
occurred in Section III.)
158. Have you ever been a patient in any type of hospital (including
being kept overnight)? (If "yes", specify when, where, why, and
name of doctor and complete address of hospital in Section III.)
SUPPLEMENTAL QUESTIONS (Continued)
Page 4 of 7 Pages
DD FORM 2807-2, MAR 2015
140. Nervous trouble of any sort (anxiety or panic attacks)
139. Been evaluated or treated, either with medication or counseling,
for a mental condition, depression or excessive worry
136. Been expelled or suspended from school
138. Been arrested or other encounters with law enforcement
137. Been kicked out or removed from your home
SOCIAL SECURITY NUMBER (Last 4)
LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)
SECTION III - APPLICANT COMMENTS (Continued).
SECTION IV - HEALTH CARE PROVIDER/INSURANCE CARRIER CONTACT INFORMATION:
Current Primary Care Physician(s)/Practitioner(s) and/or Clinic(s) where care is received and Current/Previous Insurance Carrier(s) information.
Attach additional sheets if necessary.
c. TELEPHONE (Include Area Code)b. ADDRESS (Include ZIP Code)
a. NAME(S)
1. CURRENT PRIMARY CARE PHYSICIAN(S)/PRACTITIONER(S) AND/OR CLINIC(S)
c. TELEPHONE (Include Area Code)b. ADDRESS (Include ZIP Code)
a. NAME(S)
2. PREVIOUS PRIMARY CARE PHYSICIAN(S)/PRACTITIONER(S) AND/OR CLINIC(S)
c. TELEPHONE (Include Area Code)b. ADDRESS (Include ZIP Code)
a. NAME(S)
3. CURRENT INSURANCE AND/OR PHARMACY BENEFIT MANAGER(S)
c. TELEPHONE (Include Area Code)b. ADDRESS (Include ZIP Code)
a. NAME(S)
4. PREVIOUS INSURANCE AND/OR PHARMACY BENEFIT MANAGER(S)
Page 5 of 7 Pages
DD FORM 2807-2, MAR 2015
SOCIAL SECURITY NUMBER (Last 4)
LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)
SECTION V - APPLICANT VALIDATION, AUTHORIZATION AND SIGNATURE
STOP AND READ: THE FOLLOWING STATEMENTS APPLY TO SIGNATURES IN SECTION V (BELOW)
l
l
l
l
l
l
l
l
I (we) , the undersigned:
Certify the information on this form is true and complete to the best of my knowledge and belief, and no person has advised me
to conceal or falsify any information about my physical and mental history.
Authorize and understand that a physical examination is part of the accession evaluation, may require several visits to the Military
Entrance Processing Station (MEPS), and that I will have blood work and/or other medical tests, procedures and/or specialty
consultations performed as part of my processing. I understand that the results of the examination, tests, and consults will be
reviewed and considered as part of my application file and are not performed as part of an individual healthcare treatment plan.
The MEPS medical staff are not my healthcare providers. If I do not receive notice of an abnormal test or consult, I am not to
assume that the results are normal. Furthermore, if any test or consult results are abnormal, I am responsible for obtaining those
results from the MEPS and for any necessary follow-up evaluations and/or treatment. If I am notified to return to the MEPS to
discuss medical results, it is my responsibility to take quick action to return to the MEPS to speak with the Chief Medical Officer
(CMO). Any concerns that I have about my health and healthcare are my responsibility to address with my personal healthcare
provider(s).
Understand that I must provide required documentation regarding my health history which, upon my accession, will become part
of my Service member lifecycle medical treatment record.
Authorize the Department of Defense (DoD) to request holders of medical/behavioral health data (including but not limited to
healthcare providers, clinics, hospitals, insurance companies, pharmacy benefit managers, pharmacies, health information
exchanges, and federal and state agencies) to release to the DoD medical authority a complete transcript of my health data for
purposes of processing my application for Military Service. I also authorize holders of my health data to report to the DoD
whether any data they hold or have held about me has been amended or restricted. I agree that all personal information or data
disclosed by myself or others on my behalf with my consent during this process may be further disseminated as needed during the
accession process and that my medical information is no longer protected by federal Health Insurance Portability and
Accountability Act (HIPAA) Privacy Rules.
Authorize release of records and information relating to grades, performance, individual education plans, and disciplinary
proceedings. Under the Family Educational Rights and Privacy Act (FERPA) USMEPCOM is authorized to receive all my
education/disciplinary records for evaluation of my acceptability for Service in the Armed Forces.
Understand that I have the right to refuse to sign this authorization but also understand that failure to do so may cause me to be
found disqualified for further processing.
Understand this authorization will expire two years from the date of the signature below or sooner if written request is received by
USMEPCOM Staff Judge Advocate’s Office. I have the right to revoke this authorization in writing, except to the extent that the
DoD has acted in reliance on this information.
c. DATE SIGNED (YYYYMMDD)
b. SIGNATURE
a. NAME (Last, First, Middle Initial)
2. PARENT OR GUARDIAN SIGNATURE IS MANDATORY FOR MINOR APPLICANT,
SIGNATURE IS OPTIONAL IF APPLICANT IS OF AGE
b. DATE SIGNED (YYYYMMDD)
a. SIGNATURE
1. APPLICANT
d. DATE SIGNED (YYYYMMDD)
c. SIGNATURE
b. RECRUITER
IDENTIFICATION NUMBER
a. NAME (Last, First, Middle Initial)
3. RECRUITING REPRESENTATIVE: (If a representative was used)
I certify all information is complete and true to the best of my knowledge.
Page 6 of 7 Pages
DD FORM 2807-2, MAR 2015
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
SOCIAL SECURITY NUMBER (Last 4)
LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)
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:
1.a. DATE
(YYYYMMDD)
h. DATE (YYYYMMDD)
b. MEDICAL PROCESSING STATUS
ON EXAM:
i. PROVIDER INITIALS
d. *AE g. *OEf. *MEe. *REc. NPSb. PSN INCOMa. PSN COMP
PA PULHES SMWRA INPUT
CONDITIONICDMETR PNJRJPHPRW
d. PROVIDER
INITIALS
c. IF NOT WITHIN STANDARDS:
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.
KEY:
PSN = Prescreen; COMP = Complete; INCOM = Incomplete; NPS = Not Prescreened; AE = Applicant Error; RE = Recruiter Error; ME = MEPS Error; OE =
Other Source of Error.
2. *FOR MEPS USE ONLY:
3. AUTHORIZING MEDICAL PROVIDER
4. NUMBER OF
ADDITIONAL
SHEETS
SUBMITTED
c. DATE SIGNED (YYYYMMDD)
b. SIGNATURE
a. NAME (Last, First, Middle Initial)
Page 7 of 7 Pages
DD FORM 2807-2, MAR 2015
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

form must be completed by the applicant with (NAVSUP - Naval Supply Systems Command)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 19 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document