DA Form 5074-R Record of Award of Entry Grade Credit (Medical and Dental Officers)

DA Form 5074-R - also known as the "Record Of Award Of Entry Grade Credit (medical And Dental Officers)" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 5074-R - was last revised on February 1, 1982. Download an up-to-date fillable PDF version of the DA 5074-R below or request a copy through the chain of command.

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RECORD OF AWARD OF ENTRY GRADE CREDIT (MEDICAL AND DENTAL OFFICERS)
For use of this form, see AR 135-101 and AR 601-100; the proponent agency is The Office of The Surgeon General.
2. CORPS
3. DATE OF APPOINTMENT
4. SPECIALTY IN WHICH APPOINTED
1. NAME (Last, first, MI)
MED
DEN
PART I - CONSTRUCTIVE SERVICE CREDIT
SECTION A - CREDIT FOR BASIC QUALIFYING DEGREE
5. TITLE OF DEGREE
6. DATE GRANTED
7. INCLUSIVE DATES OF ATTENDANCE
8. NAME AND LOCATION OF ACADEMIC INSTITUTION
9. CREDIT AWARDED
SECTION B - CREDIT FOR INTERNSHIP
11. INCLUSIVE DATES
12. CREDIT AWARDED
10. WHERE PERFORMED
SECTION C - CREDIT FOR GRADUATE PROFESSIONAL EDUCATION
16. CREDIT AWARDED
13. TYPE TNG & SPECIALTY
14. CERTIFYING BOARD
15. INCLUSIVE DATES
SECTION D - CREDIT FOR ADVANCED EDUCATION BEYOND BASIC QUALIFYING DEGREE
20. CREDIT AWARDED
17. DEGREE
18. ACADEMIC INSTITUTION
19. INCLUSIVE DATES
SECTION E - CREDIT FOR PROFESSIONAL EXPERIENCE
23. CREDIT AWARDED
21. LOCATION OF PRACTICE
22. INCLUSIVE DATES
SECTION F - CREDIT FOR TRAINING OR EXPERIENCE IN UNUSUAL CASES
26. CREDIT AWARDED
24. BASIS FOR AWARD
25. INCLUSIVE DATES
27. JUSTIFICATION FOR CLASSIFICATION AS UNUSUAL CASE (Attach additional pages as necessary)
PART II - PRIOR ACTIVE COMMISSIONED SERVICE CREDIT
SECTION A - CREDIT FOR SERVICE AS A
MEDICAL OFFICER OR
DENTAL OFFICER
28. UNIFORMED SVC & STATUS
29. INCLUSIVE DATES
30. CREDIT AWARDED
SECTION B - CREDIT FOR SERVICE AS OTHER THAN A MEDICAL OR DENTAL OFFICER
31. UNIFORMED SVC & STATUS (Include Corps or Specialty)
32. INCLUSIVE DATES
33. CREDIT AWARDED
PART III - COMPUTATION OF ENTRY GRADE AND DATE OF RANK
34. TOTAL CONSTRUCTIVE
35. TOTAL PRIOR SVC CREDIT
36. TOTAL ENTRY GRADE
37. ADJUSTED TOTAL ENTRY GRADE
CREDIT
(Years, Months, Days)
CREDIT (Years, Months, Days)
CREDIT (Years, Months, Days)
38. GRADE FOR WHICH CREDIT QUALIFIES
ENTRY GRADE CREDIT IS LIMITED
TO 14 YEARS, 0 MONTHS, SEE
39. CREDIT REQUIRED FOR GRADE (Years, Months, Days)
AR 601-100 OR AR 135-101 FOR
40. CREDIT IN EXCESS OF THAT REQUIRED FOR GRADE
JUSTIFICATION AND WAIVER RE-
41. DATE OF ENTRY ON ACTIVE DUTY (Or date of appointment)
QUIREMENTS FOR AMOUNTS IN
42. LESS EXCESS CREDIT
EXCESS OF 14 YEARS.
43. DATE OF RANK
PART IV - AUTHENTICATION
44. TYPED NAME/GRADE OF PREPARING OFFICIAL
SIGNATURE
DATE PREPARED
45. TYPED NAME/GRADE OF APPROVING OFFICIAL
SIGNATURE
DATE
DA FORM 5074-R, FEB 1982
(See instructions on reverse)
APD LC v1.01ES
RECORD OF AWARD OF ENTRY GRADE CREDIT (MEDICAL AND DENTAL OFFICERS)
For use of this form, see AR 135-101 and AR 601-100; the proponent agency is The Office of The Surgeon General.
2. CORPS
3. DATE OF APPOINTMENT
4. SPECIALTY IN WHICH APPOINTED
1. NAME (Last, first, MI)
MED
DEN
PART I - CONSTRUCTIVE SERVICE CREDIT
SECTION A - CREDIT FOR BASIC QUALIFYING DEGREE
5. TITLE OF DEGREE
6. DATE GRANTED
7. INCLUSIVE DATES OF ATTENDANCE
8. NAME AND LOCATION OF ACADEMIC INSTITUTION
9. CREDIT AWARDED
SECTION B - CREDIT FOR INTERNSHIP
11. INCLUSIVE DATES
12. CREDIT AWARDED
10. WHERE PERFORMED
SECTION C - CREDIT FOR GRADUATE PROFESSIONAL EDUCATION
16. CREDIT AWARDED
13. TYPE TNG & SPECIALTY
14. CERTIFYING BOARD
15. INCLUSIVE DATES
SECTION D - CREDIT FOR ADVANCED EDUCATION BEYOND BASIC QUALIFYING DEGREE
20. CREDIT AWARDED
17. DEGREE
18. ACADEMIC INSTITUTION
19. INCLUSIVE DATES
SECTION E - CREDIT FOR PROFESSIONAL EXPERIENCE
23. CREDIT AWARDED
21. LOCATION OF PRACTICE
22. INCLUSIVE DATES
SECTION F - CREDIT FOR TRAINING OR EXPERIENCE IN UNUSUAL CASES
26. CREDIT AWARDED
24. BASIS FOR AWARD
25. INCLUSIVE DATES
27. JUSTIFICATION FOR CLASSIFICATION AS UNUSUAL CASE (Attach additional pages as necessary)
PART II - PRIOR ACTIVE COMMISSIONED SERVICE CREDIT
SECTION A - CREDIT FOR SERVICE AS A
MEDICAL OFFICER OR
DENTAL OFFICER
28. UNIFORMED SVC & STATUS
29. INCLUSIVE DATES
30. CREDIT AWARDED
SECTION B - CREDIT FOR SERVICE AS OTHER THAN A MEDICAL OR DENTAL OFFICER
31. UNIFORMED SVC & STATUS (Include Corps or Specialty)
32. INCLUSIVE DATES
33. CREDIT AWARDED
PART III - COMPUTATION OF ENTRY GRADE AND DATE OF RANK
34. TOTAL CONSTRUCTIVE
35. TOTAL PRIOR SVC CREDIT
36. TOTAL ENTRY GRADE
37. ADJUSTED TOTAL ENTRY GRADE
CREDIT
(Years, Months, Days)
CREDIT (Years, Months, Days)
CREDIT (Years, Months, Days)
38. GRADE FOR WHICH CREDIT QUALIFIES
ENTRY GRADE CREDIT IS LIMITED
TO 14 YEARS, 0 MONTHS, SEE
39. CREDIT REQUIRED FOR GRADE (Years, Months, Days)
AR 601-100 OR AR 135-101 FOR
40. CREDIT IN EXCESS OF THAT REQUIRED FOR GRADE
JUSTIFICATION AND WAIVER RE-
41. DATE OF ENTRY ON ACTIVE DUTY (Or date of appointment)
QUIREMENTS FOR AMOUNTS IN
42. LESS EXCESS CREDIT
EXCESS OF 14 YEARS.
43. DATE OF RANK
PART IV - AUTHENTICATION
44. TYPED NAME/GRADE OF PREPARING OFFICIAL
SIGNATURE
DATE PREPARED
45. TYPED NAME/GRADE OF APPROVING OFFICIAL
SIGNATURE
DATE
DA FORM 5074-R, FEB 1982
(See instructions on reverse)
APD LC v1.01ES
INSTRUCTIONS
(Paragraph references below refer to AR 135-101 unless otherwise indicated)
11. Items 36. Enter total of items 34 and 35.
1. Items not discussed below are considered self-
explanatory.
12. Item 37. Enter the smaller of item 36 or 14
2. Item 3. Enter the date of entry on active duty
years 0 months unless waiver of maximum entry
unless the officer is not to enter on active duty in
grade credit has been granted. If waiver granted,
which case enter date of oath of office (effective date
enter total amount of credit awarded.
of appointment). Enter by numerals, year, month and
13. Items 38 and 39. If the officer is to enter
day.
on active duty compare the credit in item 37 with
the entries in appropriate DA Cir 601 series for
3. Item 4. Enter the specific specialty within
the fiscal year of entry on active duty. If the
medicine or dentistry in which officer is to serve.
officer is not to enter on active duty, compare the credit
in item 37 with the entries in paragraph 3-2
4. Item 5. Enter title of medical or dental degree.
Determine the grade which the credit justifies.
Enter the grade in item 38 and the credit required for
5. Items 9, 12, 16, 20, 23, 26, 30, and 33. Refer to
that grade in item 39.
Chapter 3 and its tables for amounts of credit
authorized and maximum credit when applicable.
14. Item 40. Subtract item 39 from item 37
and enter result in item 40 (years, months, days).
6. Items 10 and 13. If officer performed a straight
internship in a specialty which credits that period
15. Item 41. Enter date from item 3.
of time as first year GME, enter the training in item
13 and leave item 10 blank. Do not enter any
16. Items 42, 43 and 44. Enter the data from item
period of time more than once.
40 in item 42. Subtract 42 from 41 and enter the
result in item 43. This is the date of rank.
7. Item 24. Credit may not be awarded for
experience in this item until maximum credit for
17. Items 44 and 45. See paragraph 3-1 for
experience has been awarded in section E (item 21).
discussion of form authentication.
8. Items 28 (see Items 2 and 3, Table 3-2) and 31
(see Items 1, 4 and 5, Table 3-2). Enter service
and status, e.g., Army, Reserve on active duty;
Navy, Reserve not on active duty. In Item 31 include
Corps or Specialty.
9. Item 34. Enter total of items 9, 12, 16, 20, 23
and 26.
10. Item 35. Enter total of items 30 and 33.
REVERSE OF DA FORM 5074-R
APD LC v1.01ES
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