CUI // PRVCY — DEMONSTRATION ENVIRONMENT · NOTIONAL DATA ONLY

Reyes, Dana R.HM2

EDIPI1234567890

SexF

DOB1994-06-14

Age32

ServiceNavy

ComponentActive

Unit1MARDIV

PULHES111111

DeployabilityCategory 2

IMR: PMRDLMC 1Dental: FMRPHA: PMRImmunization: PMRLabs: NMRMedical Equipment: FMR

Provider Forms / DD FORM 2992

← Provider Forms

DD FORM 2992

Medical Recommendation for Flying or Special Operational Duty

Aviation / special-duty medical recommendation

Special duty

Routing & identification

Blocks 1–10. May be completed by clinic staff or the service member. Block 5 uses the DoD ID number (Coast Guard: Employee ID). Block 9 records the Flying Class category and duty performed. All dates in YYYYMMDD.

1. To

2. From

3. Date (YYYYMMDD)

4. Member name (Last, First, Middle Initial)

5. Identification number (DoD ID · Coast Guard Employee ID)

6. Grade

7. Date of birth (YYYYMMDD)

8. Organization

9. Type of duty (Flying Class category and duty performed)

10. Flight physical date (YYYYMMDD, if applicable)

Service component

11. UP — Found qualified by medical authority

The above individual has been found qualified by medical authority. Mark the appropriate boxes (Block 11a–c).

11a. Qualification basis (X one)

Cleared after Cleared after flight duty medical examination

Cleared after (X)

Temporary medical disqualification Waiver recommended (Not USAF) Aircraft mishap Reporting to new duty station Waiver granted Other (See remarks)

11b. Effective date (YYYYMMDD)

11c. Expiration date (YYYYMMDD)

12. DOWN — Found disqualified by medical authority

The above individual has been found disqualified by medical authority. Mark the appropriate boxes (Block 12a–c).

12a. Disqualification (X one)

Temporary disqualification Permanent disqualification

Temporary disqualification due to (X)

Illness or Injury Aircraft mishap Other (See remarks)

May participate in (X)

Simulator duties Ground based flight line duties Other (See remarks)

12b. Effective date (YYYYMMDD)

12c. Estimated duration of grounding

13. Remarks / limitations

Make remarks as appropriate. Do not include any protected health information in this section.

Standard limitations (X)

Vision correction devices required in the performance of flight duties Must carry extra spectacles

Remarks / limitations

14. Provider certification

Other credentialed providers who are not flight surgeons require a flight surgeon countersignature (Air Force and Navy upslip). Army aeromedical physician assistants and aviation medicine nurse practitioners do not require a countersignature for Army personnel only.

14. Provider type (X one)

Flight surgeon Other (countersignature required for Air Force and Navy upslip)

14a. Typed name (Last, First, Middle Initial)

14b. Grade

14c. Provider signature

14d. Date signed (YYYYMMDD)

14e. Typed name (Last, First, Middle Initial)

14f. Grade

14g. Flight surgeon countersignature

14h. Date signed (YYYYMMDD)

15. Member certification

15a. I certify that I understand the above recommendations. Selecting “May not” does not prohibit simulator duties or ground based flight line duties if those boxes are marked in Block 12.

15a. I certify that I (X one)

May perform flight duties May not perform flight duties

15b. Aircrew member signature

15c. Date signed (YYYYMMDD)

16. Action taken by commander

Not required for Air Force and Navy.

16. Action (X one)

Approve Disapprove

16a. Typed name (Last, First, Middle Initial)

16b. Title

16c. Signature

16d. Date signed (YYYYMMDD)

Paratus · DD FORM 2992 — Paratus-native form

DD FORM 2992 — Medical Recommendation for Flying or Special Operational Duty · build 2026-07-19 · Demonstration — notional data only