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How to fill out the Da 2173 online
The DA 2173 form, also known as the statement of medical examination and duty status, is essential for documenting medical evaluations and duty statuses. This guide provides clear, step-by-step instructions on how to complete the form accurately and efficiently online.
Follow the steps to fill out the form correctly.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling in the personal information of the individual examined. Enter their name, social security number, organization, station, and grade in the appropriate fields.
- Provide the accident information, including the date and place (city and state) where the incident occurred.
- In Section I, completed by the attending physician or hospital patient administrator, specify whether the individual was an outpatient, admitted, or dead on arrival. Provide the name of the hospital or treatment facility, as well as the hour and date admitted and examined.
- Detail the nature and extent of the injury or disease, and give the medical opinion on the case. Indicate if the individual was under the influence of drugs or alcohol and include additional notes if necessary.
- Complete Section II, which is for the unit commander or unit adviser. Document the duty station, whether the individual was present for duty, absent with or without authority, and details about any training.
- Provide details of the accident or the history of the disease, including explanations of how the incident interfered with military duty if applicable. Make sure to indicate if a formal line of duty investigation is required.
- Finalize the form by typing or printing the names and signatures of the attending physician or patient administrator, and unit commander or unit adviser in the designated spaces.
- Once all fields are completed, review the information for accuracy before saving any changes, downloading, printing, or sharing the form.
Complete the DA 2173 form online to ensure accurate documentation and compliance with requirements.
The DA form 2173 serves to document injuries or medical incidents that occur while on active duty. This form is essential for processing claims related to medical treatment and disability benefits. By utilizing the DA 2173, service members can ensure their injuries are officially recorded, enabling them to access the appropriate support. Explore our platform at uslegalforms for helpful tools that simplify understanding how to use the DA 2173 effectively.