DD 2808 — Report of Medical Examination

Prescribed by DoDI 1304.2 · Page 1 of 4

Administrative & Purpose

Items 1–16. Identity and demographics are prepopulated from the personnel and readiness record; confirm and complete the purpose of examination.

Items 1–13 · Identity (prepopulated)

3 · Last, First, Middle (Suffix)

1 · Date of examination (YYYYMMDD)

2a · SSN

2b · DoD ID number

6 · Grade / rank

7 · Date of birth (YYYYMMDD)

8 · Age

9 · Sex

13 · Organization unit & UIC/code

15a · Service

15b · Component

11 · Total years government service

Item 15c · Purpose of examination

15cSelect the purpose of this examination.

Required

43Dental defects and disease — acceptability

Required

Mirrors the DD 2813 dental readiness determination.

Complete required items to continue.

Page 1 of 4 · Items 17–44

Clinical Evaluation

Check each system Normal, Abnormal, or Not Evaluated (NE). Marking Abnormal opens an inline note that flows to Item 44. Every listed item requires a mark.

Item 44: enter a comment for every abnormality identified in items 17–43.
System	Normal	Abnormal	NE
17Head, face, neck, and scalp

18Nose

19Sinuses

20Mouth and throat

21Ears — general (int./ext. canals; auditory acuity under 71)

22Tympanic membranes (perforation)

23Eyes — general

24Ophthalmoscopic

25Pupils (equality and reaction)

26Ocular motility (parallel movements, nystagmus)

27Heart (thrust, size, rhythm, sounds)

28Lungs and chest (include breasts)

29Vascular system (varicosities, etc.)

30Anus and rectum (hemorrhoids, fistulae; prostate if indicated)

31Abdomen and viscera (include hernia)

32External genitalia (genitourinary)

33Upper extremities

34Lower extremities (except feet)

35Feet

36Spine, other musculoskeletal

37Body marks, scars, tattoos

38Skin, lymphatics

39Neurologic

40Psychiatric (specify any personality disorder)

41Pelvic (females only)

42Endocrine

Item 35 · Feet (if abnormal)

35a · Arch

35b · Severity

Mark all clinical items to continue.

Page 2 of 4 · Items 45–73

Labs, Measurements & Vision

Laboratory findings and objective measurements. Values shown in blue are prepopulated from the results interface; confirm or overwrite.

Items 45–52 · Laboratory findings

45 · Urinalysis — albumin

45 · Urinalysis — sugar

46 · Urine HCG

47 · H/H

48 · Blood type

49 · HIV

50 · Drugs

51 · Alcohol

Items 53–60 · Measurements

53 · Height (in.)

54 · Weight (lbs.)

55d · BMI

56 · Temperature (°F)

57 · Heart rate (bpm)

58a · Blood pressure — 1st (sys/dias)

59Red/Green & distance vision screen result

Required

61 · Distance vision — Right 20/20 corr., Left 20/20 corr. (prepopulated).

Items 71–72 · Audiometer & reading test

72aReading aloud test

Required

72bValsalva

Required

Item 73 · Notes and/or interval history

Complete required items to continue.

Pages 3–4 · Items 74–89

Physical Profile & Certification

Reviewing provider records the PULHES physical profile, qualification decision, disqualifying diagnoses, and certification.

Item 74 · Examinee

74Qualification determination

Required

A "not medically qualified" determination requires listing the disqualifying diagnosis in Item 77 and routing to the reviewing/approving authority (Item 85). May initiate a Medical Evaluation Board.

Item 76 · Physical profile (PULHES) 1 = high · 4 = low

P · Physical

U · Upper

L · Lower

H · Hearing

E · Eyes

S · Psychiatric

Profile: 1 1 1 1 1 1

Items 77–79 · Diagnoses & recommendations

77 · Significant or disqualifying medical diagnoses (list with ICD codes; item numbers from clinical evaluation).

78 · Summary of medical diagnoses / 79 · Recommendations

Items 82–87 · Certification

82a · Physician / examiner name

85a · Reviewing / approving authority

87Waiver granted?

Required

82b / 85b · Signatures

Signatures captured at sign-off · CAC / PKI

Complete required items to enable sign-off.