OPNAVINST 6110.1 · Physical Readiness Program
Section 1 · Member Referral
Medical clearance and waiver record for the Physical Fitness Assessment (PFA), covering the Physical Readiness Test (PRT) events and Body Composition Assessment (BCA). Completed by the member, treating provider, AMDR, and Commanding Officer in turn.
Patient identification (prepopulated)
Command (completed by member)
E · Reason for referral
Positive PARFQ screening?
Required
Injury / illness?
Required
Completed by treating provider or AMDR
Section 2 · Provider Clearance
A · PRT waiver recommended (by event)
B · Cardio event modification clearance
A cardio waiver is NOT required if the member is cleared for at least one modification, unless the command is not authorizing the alternate event(s).
| Alternate PRT activity | Cleared? — Yes | No |
|---|---|---|
| Treadmill | ||
| Rower | ||
| Stationary bike | ||
| Swim |
C · Physical training clearance
Command PT / Fitness Enhancement Program
Required
Individual physical training
Required
D–F · Provider certification
Treating physician + AMDR / supervising physician
Section 3 · BCA Waiver
ABCA waiver recommended? (requires two physician signatures)
Required
B · Reason IAW OPNAVINST 6110.1 (series):
Signature · CAC / PKI
Signature · CAC / PKI
Completed by AMDR only · final recommendation
Section 4 · AMDR Final Recommendation
AMember cleared for full PFA?
Required
BPRT waiver recommended? (specify events)
CBCA waiver recommended?
Required
DSecond consecutive waiver for the same medical condition?
Required
A second consecutive waiver for the same condition may trigger Medical Evaluation Board (MEB) review — flag for the CO endorsement in Section 5.
CO endorsement required prior to PRIMS input
Section 5 · CO Endorsement
A · Waiver status
BPRT waiver approved?
Required
CBCA waiver approved?
Required
Signature captured at sign-off · CAC / PKI