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Get DA 7349-R 2002-2022

SSN 13a. PRINTED/TYPED NAME DA FORM 7349 MAR 2002 10. RANK/GRADE 11. MOS 12. DATE 13b. SIGNATURE PREVIOUS EDITIONS ARE OBSOLETE USAPA V1. INITIAL MEDICAL REVIEW - ANNUAL MEDICAL CERTIFICATE For use of this form see AR 40-501 the proponent agency is OTSG DATA REQUIRED BY THE PRIVACY ACT OF 1974 Authority Section 133 Title 10 United States Code 10 USC 133. Purpose The primary use of this information is to provide medical information of sufficient detail to ensure uniformity in medical evaluation* Routine Uses Used to evaluate soldiers in terms of medical conditions and physical defects which may require medical care or which may require a determination of medical fitness for duty. Disclosure The requested information is mandatory because of the need to document all medical incidents in view of future rights and benefits. If the requested information is not furnished comprehensive health care may not be possible but CARE WILL NOT BE DENIED. PART I -- COMPLETED BY SOLDIER Please check the appropriate response column for each question below. YES NO 1. Do you currently have any medical/dental problems 2. Have you had any medical or dental problems since your last periodic physical examination 3. Have you been seen by or been treated by a dentist physician or other health care provider since your last periodic physical examination 4. Have you been hospitalized or had surgery since your last periodic physical examination 5. Are you currently taking medication or have you taken prescription medication since your last examination other type of compensation for health or physical reason 7. LIST ANY MEDICATIONS YOU ARE CURRENTLY TAKING 8. EXPLAIN ANY POSITIVE ANSWERS GIVEN ABOVE I certify that the above information is true and correct to the best of my knowledge. I further understand that false statements made on this form may be cause for reassignment discharge or other disciplinary action* 9. 00 14. INITIAL REVIEWER S NOTES FULLY FIT REQUIRES FURTHER EVALUATION 18. PHYSICIAN S REVIEW NOTES FIT UNFIT USAR refer to para 9-13 9-14 AR 40-501 UNFIT Army National Guard refer to MDRB 21. DA FORM 3349 IS ATTACHED 20. Complete PULHES using the Physical Profile Functional Capacity Guide in Table 7-1 22. INITIAL MEDICAL REVIEW - ANNUAL MEDICAL CERTIFICATE For use of this form see AR 40-501 the proponent agency is OTSG DATA REQUIRED BY THE PRIVACY ACT OF 1974 Authority Section 133 Title 10 United States Code 10 USC 133. Purpose The primary use of this information is to provide medical information of sufficient detail to ensure uniformity in medical evaluation* Routine Uses Used to evaluate soldiers in terms of medical conditions and physical defects which may require medical care or which may require a determination of medical fitness for duty. Purpose The primary use of this information is to provide medical information of sufficient detail to ensure uniformity in medical evaluation* Routine Uses Used to evaluate soldiers in terms of medical conditions and physical defects which may require medical care or which may require a determination of medical fitness for duty. Disclosure The requested information is mandatory because of the need to document all medical incidents in view of future rights and benefits. .

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