Paratus · DD FORM 2808 — Report of Medical Examination

Identification (Items 1–15)

Report of Medical Examination — administrative and demographic data.

1. Date of Examination (YYYYMMDD)

2a. Social Security Number

2b. DoD ID Number (If applicable)

3. Last Name - First Name - Middle Name (Suffix)

4. Home Address (Street, Apartment Number, City, State and Zip Code)

5a. Home Telephone Number (Include Area Code)

5b. E-mail Address

6. Grade/Rank

7. Date of Birth (YYYYMMDD)

8. Age

9. Sex

MaleFemale

11a. Total Years Government Service — Military

11b. Total Years Government Service — Civilian

12. Agency (Non-Service Members Only)

13. Organization Unit and UIC/Code

14a. Rating or Specialty (Aviators Only)

14b. Total Flying Time

14c. Last Six Months

15a. Service

15b. Component

Current duty status (Reserve/Guard)

Line of Duty (LOD) status

⚠ Reserve Component member — periodicity follows the drill cycle; complete Line of Duty items.

Clinical Evaluation (Items 17–44)

Check each item in appropriate column. Enter “NE” if not evaluated. A mandatory comment (item 44) is required for every abnormality.

No.	Examination	Normal	Abnormal	NE
17	Head, face, neck and scalp
18	Nose
19	Sinuses
20	Mouth and throat
21	Ears - General (Int. and ext. canals / Auditory acuity under item 71)
22	Tympanic Membranes (Perforation)
23	Eyes - General
24	Ophthalmoscopic
25	Pupils (Equality and reaction)
26	Ocular motility (Associated parallel movements, nystagmus)
27	Heart (Thrust, size, rhythm, sounds)
28	Lungs and chest (Include breasts)
29	Vascular system (Varicosities, etc.)
30	Anus and rectum (Hemorrhoids, Fistulae) (Prostate if indicated)
31	Abdomen and viscera (Include hernia)
32	External genitalia (Genitourinary)
33	Upper extremities
34	Lower extremities (Except feet)
35	Feet (Check category)
36	Spine, other musculoskeletal
37	Body marks, scars, tattoos
38	Skin, lymphatics
39	Neurologic
40	Psychiatric (Specify any personality disorder)
41	Pelvic (Females only)
42	Endocrine

44. Notes (Mandatory comment for every abnormality in items 17–43; enter the item number before each comment)

Laboratory Findings (Items 45–52)

Item	Test	Results
45a	Urinalysis — Albumin
45b	Urinalysis — Sugar
46	Urine HCG
47	H/H (Hemoglobin/Hematocrit)
48	Blood Type
49	HIV
50	Drugs
51	Alcohol
52	Other
52a	PAP Smear
52b	EKG
52c	CXR

Measurements and Other Findings (Items 53–72)

53. Height (in.)

54. Weight (lbs.)

55a. Min Wgt

55b. Max Wgt

55c. Max BF %

55d. BMI

56. Temperature

57. Heart Rate

58. Blood Pressure

Reading	Sys.	Dias.
a. 1st
b. 2nd
c. 3rd

59. Red/Green

60. Other Vision Test

61. Distance Vision

Eye	Uncorrected 20/	Corrected to 20/
Right
Left

62. Refraction (Auto / Manifest / Cyclo)

Eye	Type	Sph	Cyl	Axis
Right
Left

63. Near Vision (Add)

65. Accommodation — Right

65. Accommodation — Left

64. Heterophoria

ES	EX	R.H.	L.H.	Prism Div.	Prism Conv CT	NPR	PD

66. Color Vision (Pass/Fail and Score) — PIP

66. Color Vision — Red/Green

66. Color Vision — Color Dx

67. Depth Perception (Pass/Fail and Score) — AFVT

67. Depth Perception — RANDOT/MCST

68. Field of Vision

69. Night Vision

70. Intraocular Pressure — O.D.

70. Intraocular Pressure — O.S.

71a. Audiometer — Unit Serial Number

71a. Audiometer — Date Calibrated (YYYYMMDD)

71b. Audiometric Thresholds (HZ)

Ear	500	1000	2000	3000	4000	6000
Right
Left

72a. Reading Aloud Test

SATUNSAT

72b. Valsalva

SATUNSAT

72c. Other Testing

Notes and/or Interval History (Item 73)

73. Notes and/or Interval History

Summary of Examination (Items 74–80)

74. Examinee

Is medically qualifiedIs not medically qualified

75. Advised of disqualifying condition(s)

75a. Signature of Examinee

76. Physical Profile (PULHES)

P	U	L	H	E	S

77. Significant or Disqualifying Medical Diagnoses

Item No.	Diagnosis	Waiver Received	Service	WKID

78. Summary of Medical Diagnoses (List diagnoses with item numbers)

79. Recommendations (Specify)

80. MEPS Workload (For MEPS use only) — WKID

Medical Inspection Date (Item 81)

Row	Date 1	Date 2	Date 3
Height (HT)
Weight (WT)
Body Fat % (%BF)
Maximum Weight (Max WT)
HCG
Qual
Disq

Examiner’s Name and Signature (Items 82–89)

82a. Typed or Printed Name of Physician or Examiner

82b. Signature

83a. Typed or Printed Name of Physician or Examiner

83b. Signature

84a. Typed or Printed Name of Dentist or Physician (Indicate which)

84b. Signature

85a. Typed or Printed Name of Reviewing Officer / Approving Authority (Indicate which)

85b. Signature

86. This examination has been administratively reviewed for completeness and accuracy.

86a. Signature

86b. Grade

87. Waiver Granted (If yes, date and by whom)

YesNo

87. Waiver details (date and by whom)

88. Number of Attached Sheets

89. Additional Remarks