Just after filling out this step, go to the next part and enter the essential particulars in all these blanks - SINCE YOUR LAST MEDICAL, YES, SINCE YOUR LAST MEDICAL, YES, HAVE YOU SUFFERED FROM ANY INJURY, YES, ARE YOU NOW TAKING ANY, YES, DO YOU HAVE ANY CONDITIONS WHICH, YES, DO YOU HAVE ANY DENTAL PROBLEMS X, and YES.ģ. To begin with, while completing the medical assessment physical, beging with the section that contains the subsequent fields:Ģ. Make certain all necessary blank fields are filled out correctly.ġ. Try all the functions and make your docs seem sublime with custom text added, or optimize the file's original input to excellence - all comes along with the capability to incorporate your personal photos and sign the document off. Step 2: With this state-of-the-art PDF editor, you're able to do more than simply complete blank fields. ![]() Step 1: First, open the pdf editor by clicking the "Get Form Button" in the top section of this site. Enjoy an ever-evolving experience now! With some simple steps, you can start your PDF editing: Our team is relentlessly working to enhance the tool and help it become even faster for people with its multiple functions. In case you need to fill out medical assessment physical, you won't need to download and install any kind of programs - simply use our PDF editor. ![]() SEPARATION (Includes discharge f rom milit ary service and release f rom act ive dut y, including release of Nat ional Guard and Reserve personnel volunt arily or involunt arily called or ordered t o act ive dut y.) WAS PATIENT REFERRED FOR FURTHER EVALUATION? (X one. ![]() HEALTH CARE PROVIDER COM M ENTS (All pat ient complaint s must be addressed)Ģ1. " Worse" t o It em 10 or " Yes" t o It ems 11, 12, or 14 t hrough 18, document at ion of t he injury, illness, or problem should be included in t he service member' s medical or dent al record.Ģ0. Any service member w ho has indicat ed " yes" t o It em 18 w ill have an appropriat e physical examinat ion, if t he last examinat ion is more t han 12 mont hs old and/or t here are new signs and/or sympt oms. Any service member w ho request s a physical examinat ion may have one. The assessment w ill cover, as a minimum, t he period since t he service member' s last medical assessment /physical examinat ion, or t he period of t his call or order t o act ive dut y. This Report of Medical Assessment is t o be used by t he Medical Services t o provide a comprehensive medical assessment f or act ive and reserve component service members separat ing or ret iring f rom act ive dut y. SECTION II - TO BE COM PLETED BY INDIVIDUALLY PRIVILEGED HEALTH CARE PROVIDER I certify that the information provided above is true and complete to the best of my know ledge. If " Yes," list condit ions f or w hich you w ill ask f or VA Disabilit y.)ġ9. AT THE PRESENT TIM E, DO YOU INTEND TO SEEK DEPARTM ENT OF VETERANS AFFAIRS (VA) DISABILITY? DO YOU HAVE ANY OTHER QUESTIONS OR CONCERN ABOUT YOUR HEALTH? (X one. DO YOU HAVE ANY DENTAL PROBLEM S? (X one. DO YOU HAVE ANY CONDITIONS WHICH CURRENTLY LIM IT YOUR ABILITY TO WORK IN YOUR PRIM ARY M ILITARY SPECIALTY OR REQUIRE GEOGRAPHIC OR ASSIGNM ENT LIM ITATIONS? (X one. ![]() ARE YOU NOW TAKING ANY M EDICATIONS? (X one. HAVE YOU SUFFERED FROM ANY INJURY OR ILLNESS WHILE ON ACTIVE DUTY FOR WHICH YOU DID NOT SEEK M EDICAL CARE?ġ4. SINCE YOUR LAST M EDICAL ASSESSM ENT/PHYSICAL EXAM INATION, HAVE YOU BEEN SEEN BY OR BEEN TREATED BY A HEALTH CARE PROVIDER, ADM ITTED TO A HOSPITAL, OR HAD SURGERY? (X one. SINCE YOUR LAST M EDICAL ASSESSM ENT/PHYSICAL EXAM INATION, HAVE YOU HAD ANY ILLNESSES OR INJURIES THAT CAUSED YOU TO M ISS DUTY FOR LONGER THAN 3 DAYS? (X one. COM PARED TO M Y LAST M EDICAL ASSESSM ENT/PHYSICAL EXAM INATION, M Y OVERALL HEALTH IS (X one. DATE ENTERED ON CURRENT ACTIVE DUTY (YYMMDD)ġ0. DATE OF LAST PHYSICAL EXAM INATION BY THE M ILITARYĩ. HOM E STREET ADDRESS (Or RFD, includingĨ. Landlord (Tenant) Recommendation LetterĦa.
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