Get Dd Form 3176 2021-2025

Filling out the DD Form 3176 is an essential process for Department of Defense employees seeking a medical exemption or delay from the COVID-19 vaccination requirement. This guide provides a step-by-step approach to help users complete the form accurately and efficiently online.

Follow the steps to successfully complete the DD Form 3176 online.

1. Press the ‘Get Form’ button to obtain the DD Form 3176 and open it in your preferred digital editor.
2. Begin by completing Part 1 of the form, which is dedicated to the DoD civilian employee. Fill in the employee name, DoD ID number, office symbol, date of request, position/title, supervisor name, and supervisor phone number. Ensure that all fields are filled out accurately.
3. In blocks 8 through 10, provide detailed descriptions of the medical condition or circumstance that necessitates the request for exemption, explanations of why vaccination is not viable, and any additional relevant information that could assist in the evaluation of the exemption request.
4. Complete the continuation block if more space is needed. Clearly annotate the section and line number before continuing your response.
5. Sign and date the form in block 12 and 13, confirming that the information provided is true to the best of your knowledge.
6. Proceed to Part 2, which must be completed by the licensed health care provider. The provider should fill in the employee’s name and provide a medical certification regarding the medical exemption or delay.
7. In blocks 15 to 17, the health care provider should detail any contraindications or precautions regarding COVID-19 vaccination, explain how the employee's condition makes vaccination unsafe, and provide any limiting medical information.
8. The health care provider must also indicate if the condition is temporary or long-term in block 18, and provide a rationale regarding when the employee might safely receive vaccination, if applicable.
9. Finally, the health care provider should complete their information in blocks 21 to 23, including their name, title, date, and signature.
10. Once both parts of the form are completed, ensure to save any changes, download the filled-out document, print it for your records, or share it as necessary.

Complete your DD Form 3176 online today and ensure your exemption request is processed efficiently.