Form DD Form 2807-2 DD Form 2807-2 Accessions Medical Prescreen Reporty

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.
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
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”).

D R A F T

- 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 Military Entrance Processing Station (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/
healthcare provider 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.
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.

DD FORM 2807-2, 20140820 DRAFT

PREVIOUS EDITION IS OBSOLETE.

Page 1 of 7 Pages
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ACCESSIONS MEDICAL PRESCREEN REPORT

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, Information Management 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://dpclo.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx apply to this 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.”

D R A F T

SECTION I - APPLICANT

1. LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)

5. HEIGHT (inches)

6. WEIGHT (lbs.)

7. MAX WEIGHT
(lbs.)

2. AGE

U.S. Service Academy

Commission

ROTC Scholarship

Retention

Other (Specify)

4. SOCIAL SECURITY NUMBER

8. SERVICE AND COMPONENT (X as applicable)

9. DATE (YYYYMMDD)

Army

USMC

Regular

Navy

USCG

Reserve Component

USAF

Other:

National Guard

11. POSITION (If a current Federal Employee)
(Job Title, Grade, Component)

10. PURPOSE OF EXAMINATION (X as applicable)
Enlistment

3. DATE OF BIRTH (YYYYMMDD)

12. USUAL OCCUPATION

SECTION II - MEDICAL HISTORY. Initial each item "Yes" or "No". All "Yes" items must be fully explained in Section III (Pages 4 and 5).
CURRENTLY HAVE OR ANY HISTORY OF:

YES

NO

CURRENTLY HAVE OR ANY HISTORY OF:

EYES

LUNGS, CHEST WALL, PLEURA, AND MEDIASTINUM

1. Double vision

22. Asthma

2. Detached retina or surgery to repair a detached retina

23. Wheezing

3. Cataracts or surgery for cataracts

24. Shortness of breath

4. Eye surgery to improve vision (RK, PRK, LASIK, etc.)

25. Bronchitis

5. Night blindness

26. Other breathing problems worsened by exercise, weather,
pollens, etc.

6. Glaucoma
7. Strabismus or "lazy eye" or any surgery to correct these
8. Any other eye condition, injury or surgery
VISION
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.)
10. Loss of vision in either eye
11. Color vision deficiency or color blindness
EARS
12. Perforated ear drum or tubes in ear drum(s)
13. Ear surgery, to include mastoidectomy or repair of perforated
ear drum

28. Chronic cough or frequent coughing at night
29. Collapsed lung or other lung condition
30. History of chest, chest wall, or breast surgery
HEART
31. Heart murmur, valve problem or mitral valve prolapse
32. Palpitation, pounding heart or abnormal heartbeat
33. Heart surgery
34. Pain or pressure in the chest
35. An abnormal electrocardiogram (EKG)
36. Any other heart problems
ABDOMINAL ORGANS AND GASTROINTESTINAL SYSTEM
37. Stomach, esophageal or intestinal ulcer

HEARING

38. Difficulty swallowing

15. Hearing loss or wear a hearing aid

39. Frequent indigestion or heartburn

NOSE, SINUSES, MOUTH, AND LARYNX

40. Gall bladder trouble or gallstones

16. Ear, nose, or throat trouble including tonsillectomy

41. Jaundice (except neonatal) or hepatitis (liver disease)

17. Chronic sinus infections or recurrent nose bleeds

42. Rupture/hernia

18. Absence of, or disturbance of sense of smell

43. Surgery to remove or repair a portion of the intestine or spleen
(other than the appendix)

DENTAL
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.)
21. Tooth or gum problems (other than cavities)

DD FORM 2807-2, 20140820 DRAFT

NO

27. Used inhaler(s) or steroids for breathing problem(s)

14. Loss of balance or vertigo

19. Any surgery of your face, mandible or jaw

YES

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
45. Rectal disease, hemorrhoids, or blood from the rectum
46. Hemorrhoid surgery
47. Bariatric surgery (weight loss surgery)

Page 2 of 7 Pages

LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)

SOCIAL SECURITY NUMBER (Last 4)

SECTION II - MEDICAL HISTORY (Continued). Initial each item "Yes" or "No". All "Yes" items must be fully explained in Section III.
CURRENTLY HAVE OR ANY HISTORY OF:

YES

FEMALES ONLY:
48. A change of menstrual pattern (other than pregnancy)
49. Pregnancy, abortion or miscarriage

YES

NO

SKIN AND CELLULAR
93. Acne or psoriasis

95. Atopic dermatitis

51. Date of last PAP smear (YYYYMMDD)

96. Large or painful scars

52. Diagnosed with endometriosis or ovarian cysts
53. Evaluation, treatment or surgery for any other gynecological
(female) disorder
54. Sexually transmitted disease (syphilis, gonorrhea, chlamydia,
genital warts, herpes, etc.)
MALES ONLY:

CURRENTLY HAVE OR ANY HISTORY OF:

94. Eczema

50. Any abnormal PAP smear(s)

55. First day of last menstrual period (YYYYMMDD)

NO

97. Any other skin problems
BLOOD AND BLOOD FORMING TISSUES
98. Anemia

D R A F T

56. Missing a testicle, testicular implant, or undescended testicle
57. Variocele, hydrocele, or any scrotal mass, swelling or pain
58. Prostate problems
59. Sexually transmitted disease (syphilis, gonorrhea, chlamydia,
genital warts, herpes, etc.)

99. Blood clots requiring blood thinner medicine
100. Absence or removal of the spleen
101. Prolonged bleeding (after an injury or tooth extraction)
102. Any other blood or circulation problems
SYSTEMIC
103. Adverse reaction to medication (describe reaction in Section III)
104. Adverse reaction to serum, insect stings, or tree nuts

URINARY SYSTEM

105. Allergy to common foods (milk, eggs, fish, meat, etc.)

60. Missing a kidney

106. Allergy to wool, latex, or other material

61. Kidney stone, infection or disease

107. Tuberculosis or lived with someone who had tuberculosis

62. Kidney or urinary tract surgery of any kind

108. Positive test for tuberculosis (PPD or blood test)

63. Blood or protein in urine

109. Malaria

64. Painful or difficult urination

110. Disorder(s) of your immune system (including HIV)

65. Bedwetting or treatment for bedwetting (after childhood)

111. Car, train, sea, or air sickness

66. Hernia

ENDOCRINE AND METABOLIC

SPINE AND SACROILIAC JOINTS

112. Thyroid trouble or goiter

67. Recurrent back pain or back problem

113. High or low blood sugar

68. Herniated disk

114. Diabetes or told that you should be tested for diabetes

69. Recurrent neck pain

NEUROLOGIC

70. Back or neck surgery

115. Cerebrovascular incident (stroke)

71. Abnormal curvature of your spine (any part)

116. Frequent or severe headaches, including migraines

UPPER EXTREMITIES

117. Taking medication to prevent headaches

72. Painful shoulder, elbow, wrist, hand or fingers

118. Lost time from work or school due to frequent or severe
headaches

73. Dislocated shoulder, elbow, wrist, hand or fingers
LOWER EXTREMITIES
74. Foot trouble (e.g., pain, corns, bunions, warts, ingrown toenails,
etc.)

119. A skull fracture
120. A head injury, memory loss, or amnesia
121. A period of unconsciousness or concussion

75. Knee trouble (e.g., locking, giving out, or ligament injury, etc.)

122. Loss of memory or amnesia, or neurological symptoms

76. Painful hip, knee, ankle, foot or toes

123. Paralysis

77. Dislocated hip, knee, ankle, foot or toes

124. Meningitis, encephalitis, or other neurological problems

MISCELLANEOUS CONDITIONS OF THE EXTREMITIES

125. Seizures, convulsions, epilepsy or fits

78. Bone, joint, or other orthopedic deformity

126. Dizziness or fainting spells

79. Loss of finger or toe, or extra finger or toe

127. Any other neurologic problems

80. Loss of the ability to fully flex (bend) or fully extend a finger, toe,
or other joint

SLEEP DISORDERS

81. Impaired use of arms, hands, legs, or feet (any reason)
82. Arthritis, rheumatism, or bursitis
83. Any swollen joint(s)
84. Surgery on any joint/bone (including arthroscopy)

129. Sleepwalking or narcolepsy
130. Frequent trouble sleeping
131. Sleep apnea or severe snoring
LEARNING, PSYCHIATRIC, AND BEHAVIORAL

85. Plate(s), screw(s), rod(s) or pin(s) in any bone

132. Evaluated or treated for Attention Deficit Disorder (ADD) or
Attention Deficit Hyperactivity Disorder (ADHD)

86. Pain or swelling at the site of an old fracture

133. Taken (or taking) medication, drugs, or any substance to
improve attention, behavior, or physical performance

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
VASCULAR
89. High or low blood pressure
90. Raynaud's phenomenon or disease
91. Deep Vein Thrombosis (blood clot; leg or elsewhere)
92. Pulmonary embolism (blood clot in lung)

DD FORM 2807-2, 20140820 DRAFT

134. Diagnosed with a learning disorder, to include dyslexia
135. Received counseling of any type
136. 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 providers marked "CONFIDENTIAL: MEPS MEDICAL DEPARTMENT" and submit directly to MEPS medical personnel.)

Page 3 of 7 Pages

LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)

SOCIAL SECURITY NUMBER (Last 4)

SECTION II - MEDICAL HISTORY (Continued). Initial each item "Yes" or "No". All "Yes" items must be fully explained in Section III.
CURRENTLY HAVE OR ANY HISTORY OF:

YES

LEARNING, PSYCHIATRIC, AND BEHAVIORAL (Continued)

NO

CURRENTLY HAVE OR ANY HISTORY OF:

YES

136. Been expelled or suspended from school

154. Any recent unexplained gain or loss of weight

137. Been kicked out or removed from your home

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.)
157. Have you ever been treated in an Emergency Room? (If "yes",
explain in Section III.)

138. Been arrested or other encounters with law enforcement
139. Been evaluated or treated, either with medication or counseling,
for a mental condition, depression or excessive worry
140. Nervous trouble of any sort (anxiety or panic attacks)
141. Anorexia, bulimia, or other eating disorder
142. Habitual stammering or stuttering
143. Have you ever purposely cut or harmed yourself
144. Have you ever attempted or considered suicide
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
148. Post-traumatic Stress Disorder or excessive stress requiring
counseling and/or medication following a traumatic experience
149. Any other learning, psychiatric, or behavioral problems
TUMORS AND MALIGNANCIES

NO

SUPPLEMENTAL QUESTIONS (Continued)

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.)
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.)
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.)
a. Sensitivity to chemicals, dust, sunlight, etc.

150. Tumor, growth, cyst, or cancer of any type

b. Inability to perform certain motions

MISCELLANEOUS

c. Inability to stand, sit, kneel, lie down, etc.

151. Cold injury, frostbite or cold intolerance

d. Other medical reasons

152. Heat injury, heat stroke or heat intolerance
SUPPLEMENTAL QUESTIONS
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.)

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.)

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.

D R A F T

DD FORM 2807-2, 20140820 DRAFT

Page 4 of 7 Pages

LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)

SOCIAL SECURITY NUMBER (Last 4)

SECTION III - APPLICANT COMMENTS (Continued).

D R A F T

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.
1. CURRENT PRIMARY CARE PHYSICIAN(S)/PRACTITIONER(S) AND/OR CLINIC(S)
a. NAME(S)

b. ADDRESS (Include ZIP Code)

c. TELEPHONE (Include Area Code)

2. PREVIOUS PRIMARY CARE PHYSICIAN(S)/PRACTITIONER(S) AND/OR CLINIC(S)
a. NAME(S)

b. ADDRESS (Include ZIP Code)

c. TELEPHONE (Include Area Code)

3. CURRENT INSURANCE AND/OR PHARMACY BENEFIT MANAGER(S)
a. NAME(S)

b. ADDRESS (Include ZIP Code)

c. TELEPHONE (Include Area Code)

4. PREVIOUS INSURANCE AND/OR PHARMACY BENEFIT MANAGER(S)
a. NAME(S)

DD FORM 2807-2, 20140820 DRAFT

b. ADDRESS (Include ZIP Code)

c. TELEPHONE (Include Area Code)

Page 5 of 7 Pages

LAST NAME - FIRST NAME - MIDDLE INITIAL (SUFFIX)

SOCIAL SECURITY NUMBER (Last 4)

SECTION V - APPLICANT VALIDATION, AUTHORIZATION AND SIGNATURE

STOP AND READ: THE FOLLOWING STATEMENTS APPLY TO SIGNATURES IN SECTION V (BELOW)
l

I (we) , the undersigned:

l

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.

l

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).

l

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.

l

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.

l

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.

l

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.

l

D R A F T

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.

1. APPLICANT
a. SIGNATURE

b. DATE SIGNED (YYYYMMDD)

2. PARENT OR GUARDIAN SIGNATURE IS MANDATORY FOR MINOR APPLICANT,
SIGNATURE IS OPTIONAL IF APPLICANT IS OF AGE
b. SIGNATURE

a. NAME (Last, First, Middle Initial)

c. DATE SIGNED (YYYYMMDD)

3. RECRUITING REPRESENTATIVE: (If a representative was used)
I certify all information is complete and true to the best of my knowledge.
a. NAME (Last, First, Middle Initial)

b. RECRUITER
IDENTIFICATION NUMBER

DD FORM 2807-2, 20140820 DRAFT

c. SIGNATURE

d. DATE SIGNED (YYYYMMDD)

Page 6 of 7 Pages

LAST 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:

D R A F T

SECTION VII - MEDICAL PROVIDER'S PRESCREEN DETERMINATION BASED ON AVAILABLE INFORMATION:
1.a. DATE
(YYYYMMDD)

b. MEDICAL PROCESSING STATUS
PA

PRW

PH

RJ

METR

c. IF NOT WITHIN STANDARDS:
PNJ

ICD

CONDITION

PULHES

SMWRA INPUT

d. PROVIDER
INITIALS

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
b. SIGNATURE
a. NAME (Last, First, Middle Initial)
c. DATE SIGNED (YYYYMMDD)
SHEETS
SUBMITTED

DD FORM 2807-2, 20140820 DRAFT

Page 7 of 7 Pages