DATE 32. INJURY IS CONSIDERED TO HAVE BEEN INCURRED IN LINE OF DUTY Not applicable on deaths 34. TYPED NAME AND GRADE OF UNIT COMMANDER OR UNIT ADVISER DA FORM 2173 OCT 1972 REPLACES DA FORM 2173 1 JUN 66 WHICH IS OBSOLETE. APD PE v2. STATEMENT OF MEDICAL EXAMINATION AND DUTY STATUS For use of this form see AR 600-8-4 the proponent agency is DCS G-1. THRU Include ZIP Code TO Include ZIP Code FROM Include ZIP Code 1. NAME OF INDIVIDUAL EXAMINED Last First and Middle Initial 2. SSN 4. ORGANIZATION AND STATION 3. GRADE ACCIDENT INFORMATION b. PLACE City and State a* DATE SECTION I - TO BE COMPLETED BY ATTENDING PHYSICIAN OR HOSPITAL PATIENT ADMINISTRATOR OUT PATIENT DEAD ON ARRIVAL 6. INDIVIDUAL WAS ADMITTED 7. NAME OF HOSPITAL OR TREATMENT FACILITY 8. HOUR AND DATE ADMITTED INJURY a* b. INDIVIDUAL c* IS d. W AS RESULTING IN DEATH Explain DISEASE DRUGS Specify Attach Psychiatric evaluation if appropriate. IS NOT LIKELY TO RESULT IN A CLAIM AGAINST THE GOVERNMENT FOR FUTURE MEDICAL CARE* ....
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How to fill out the DA 2173 online
The DA 2173, also known as the statement of medical examination and duty status, is crucial for documenting medical examinations and duty information. This guide provides detailed instructions to effectively complete the form online, ensuring accuracy and compliance.
Follow the steps to efficiently complete the DA 2173 online.
- Click 'Get Form' button to obtain the form and open it in the digital editing tool.
- Begin by entering the individual's name in the designated fields (Last, First, and Middle Initial), ensuring proper spelling and format.
- Provide the individual's social security number (SSN) in the next field. Verify that the number is accurate to avoid processing issues.
- Fill in the organization and station information. This includes the unit's name and location, making sure to include the full ZIP code.
- Record the individual's grade in the appropriate field, using the official designations.
- In the accident information section, document the date and place of the accident, including the city and state.
- Indicate the admission status by selecting either 'Out Patient' or 'Dead on Arrival' depending on the situation.
- Enter the name of the hospital or treatment facility where the individual was admitted. Ensure the name is complete and accurate.
- Note the hour and date the individual was admitted and examined. This is critical for maintaining accurate medical records.
- Complete sections regarding the nature and extent of injuries or diseases, including any relevant details about the accident or treatment.
- Fill in the medical opinion provided by the attending physician or unit adviser, specifying any disabilities that may result.
- In the unit commander's section, indicate the individual's duty status, time of absence, and any comments about the impact on duty performance.
- After reviewing all entered information for accuracy, users may save changes, download and print the form, or share it as needed.
Complete your DA 2173 online now to ensure efficient processing of your medical examination and duty status.
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Get answers to your most pressing questions about US Legal Forms API.
What is the line of duty determination for VA disability?
The line of duty determination for VA disability establishes whether a service-connected disability arose from events occurring during active duty. If a soldier can successfully demonstrate that their condition meets these criteria, they may qualify for VA benefits. Completing forms like the DA 2173 accurately is crucial for this determination, as it helps validate the claim.
What does it mean when a Soldier dies in the line of duty?
When a soldier dies in the line of duty, it signifies that their death occurred while performing their official military responsibilities. This status affects various benefits, including life insurance and survivor compensation. Understanding the implications can help families navigate the support available to them during such a challenging time.
What is DA form 2173?
DA form 2173 is specifically designed to report injuries or illnesses incurred during active duty. This form helps establish the line of duty status of a service member, impacting eligibility for benefits. Understanding the process and properly completing this form is vital for soldiers seeking assistance for medical issues.
How to get medically discharged from the army reserves?
To receive a medical discharge from the Army Reserves, you must begin by gathering sufficient medical documentation supporting your condition. You will usually need to undergo an evaluation by a medical board that reviews your case. A properly completed DA form 2173 can support your claim by providing documented evidence of your injury or illness.
What is a DA form 2142 used for?
The DA form 2142 is used for documenting a soldier's request for a waiver of the physical fitness standard. While it is different from the DA form 2173, both forms serve critical roles in a soldier's military career. The DA 2142 requires careful attention to detail to ensure proper processing of the waiver request.
How to initiate an LOD?
To initiate a line of duty (LOD) determination, you must complete the DA form 2173 and submit it to your chain of command. This process usually starts with a verbal report of the incident, followed by gathering all relevant details and completing the form accurately. By ensuring timely submission of the DA 2173, you help facilitate the evaluation of your case.
What is a DA form 2173 used for?
The DA form 2173 is essential for documenting injuries or illnesses that occur while a soldier is on active duty. This form plays a critical role in establishing a line of duty determination. By completing the DA 2173, military personnel can ensure that their medical issues are officially recognized, which may help in obtaining the necessary support and benefits.
What is a DA form 2173?
The DA Form 2173 is a crucial document used to report and evaluate incidents that may qualify for line of duty status. This form captures essential details needed for a proper investigation into a service member's death or injury. It provides information that determines eligibility for various military benefits and support. Therefore, accurately completing the DA 2173 form is vital for protecting the rights of service members and their families.
What does it mean to die in line of duty?
Dying in line of duty means that a service member has lost their life while performing duties related to their military service. This classification carries significant implications for benefits and support for families left behind. It often connects with the completion of the DA 2173 form to document the service member's status at the time of death. Understanding this term is crucial for navigating the benefits process.
What is a military line of duty death?
A military line of duty death is a death that occurs when a service member is engaged in performing their official duties. This includes deaths from combat, training accidents, or any incidents directly related to military responsibilities. Recognizing this status is vital for surviving family members to receive appropriate benefits and assistance. The DA 2173 form plays a key role in establishing this status.
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