DA Form 2670-R "Mixed Medical Commission Certificate for Epw"

What Is DA Form 2670-R?

This is a military form that was released by the U.S. Department of the Army (DA) on May 1, 1982. The form, often mistakenly referred to as the DD Form 2670-R, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 1-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
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Download an up-to-date fillable DA Form 2670-R down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 2670-R "Mixed Medical Commission Certificate for Epw"

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MIXED MEDICAL COMMISSION CERTIFICATE FOR EPW
For use of this form, see AR 190-8; the proponent agency is PMG.
FROM:
TO:
The undersigned make up the Mixed Medical Commission. They are dully appointed under the GPW of 1949 to examine
EPW in custody of the US Armed Forces. The EPW claim eligibility for
(state nationality)
repatriation or for hospitalization in a neutral country under the provisions of that convention. The EPW named below has been presented
to the Commission and has been examined at the location, and on the date shown.
GRADE
NAME (Last, first, MI)
SERVICE NUMBER
INTERNMENT SERIAL NUMBER
DATE OF BIRTH
STATUS
MEDICAL:
LITTER
AMBULANT
SURGICAL:
LOCKED WARD
OPEN
ISOLATION
NEUROPSYCHIATRIC:
a. INELIGIBLE FOR REPATRIATION OR HOSPITALIZATION IN A NEUTRAL COUNTRY.
THE MIXED MEDICAL COMMISSION FINDS
b. ELIGIBLE FOR DIRECT REPATRIATION.
THAT THE ABOVE NAMED
c. ELIGIBLE FOR HOSPITALIZATION IN A NEUTRAL COUNTRY.
EPW IS (Check applicable box)
d. ELIGIBLE FOR RE-EXAMINATION BY NEXT COMMISSION.
FINAL DIAGNOSIS (Continue on reverse side if more space is required) .
PLACE OF EXAMINATION
DATE
TYPED NAME OF CHAIRMAN, MIXED MEDICAL COMMISSION
SIGNATURE
TYPED NAME OF MEMBER
SIGNATURE
TYPED NAME OF US MEDICAL REPRESENTATIVE
SIGNATURE
DA FORM 2670-R, MAY 1982
EDITION OF 1 JUL 63 IS OBSOLETE.
APD LC v1.01ES
MIXED MEDICAL COMMISSION CERTIFICATE FOR EPW
For use of this form, see AR 190-8; the proponent agency is PMG.
FROM:
TO:
The undersigned make up the Mixed Medical Commission. They are dully appointed under the GPW of 1949 to examine
EPW in custody of the US Armed Forces. The EPW claim eligibility for
(state nationality)
repatriation or for hospitalization in a neutral country under the provisions of that convention. The EPW named below has been presented
to the Commission and has been examined at the location, and on the date shown.
GRADE
NAME (Last, first, MI)
SERVICE NUMBER
INTERNMENT SERIAL NUMBER
DATE OF BIRTH
STATUS
MEDICAL:
LITTER
AMBULANT
SURGICAL:
LOCKED WARD
OPEN
ISOLATION
NEUROPSYCHIATRIC:
a. INELIGIBLE FOR REPATRIATION OR HOSPITALIZATION IN A NEUTRAL COUNTRY.
THE MIXED MEDICAL COMMISSION FINDS
b. ELIGIBLE FOR DIRECT REPATRIATION.
THAT THE ABOVE NAMED
c. ELIGIBLE FOR HOSPITALIZATION IN A NEUTRAL COUNTRY.
EPW IS (Check applicable box)
d. ELIGIBLE FOR RE-EXAMINATION BY NEXT COMMISSION.
FINAL DIAGNOSIS (Continue on reverse side if more space is required) .
PLACE OF EXAMINATION
DATE
TYPED NAME OF CHAIRMAN, MIXED MEDICAL COMMISSION
SIGNATURE
TYPED NAME OF MEMBER
SIGNATURE
TYPED NAME OF US MEDICAL REPRESENTATIVE
SIGNATURE
DA FORM 2670-R, MAY 1982
EDITION OF 1 JUL 63 IS OBSOLETE.
APD LC v1.01ES