Get United States Army Reserve Command

This guide provides comprehensive instructions on filling out the United States Army Reserve Command form for healthcare providers. Designed to support both experienced and new users, this guide aims to facilitate a seamless experience in completing this essential documentation online.

Follow the steps to accurately complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Fill in the date at the top of the form where indicated. This will document when the information is being submitted.
3. Provide the name of the patient in the designated space where it says ‘_____________________________.’ Ensure that the name is spelled accurately.
4. Enter your professional contact information, including your office phone and fax numbers. This information is crucial for follow-up communications.
5. List the primary diagnosis or diagnoses of the patient in the specified section. Be as detailed as possible to assist in the assessment.
6. Detail the treatments being provided to the patient in the ‘Treatment(s) include’ section.
7. Indicate whether the symptoms related to the diagnosis are permanent or temporary by circling the appropriate option.
8. If the condition is temporary, specify the duration of limitations by circling from the provided options (30, 60, 90, or 180 days).
9. Review the set of physical activity limitations provided in the form. Indicate the Soldier's ability to perform each activity by marking 'Y' for Yes or 'N' for No.
10. If applicable, mention any additional limitations the Soldier has in the designated area for other limitations.
11. Print and sign your name, providing your official stamp if necessary. Ensure that all fields are filled with accurate and relevant information.
12. Once you have completed the form, save any changes you made. You can then choose to download, print, or share the form as needed.

Begin filling out the United States Army Reserve Command form online today to ensure timely processing.