DA Form 2670-R Mixed Medical Commission Certificate for Epw

DA Form 2670-R - also known as the "Mixed Medical Commission Certificate For Epw" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 2670-R - was last revised on May 1, 1982. Download an up-to-date fillable PDF version of the DA 2670-R down below or look it up on the Army Publishing Directorate website.

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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EDITION OF 1 JUL 63 IS OBSOLETE.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

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

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