DA Form 2671-R "Certificate of Direct Repatriation for Epw"

DA Form 2671-R - also known as the "Certificate Of Direct Repatriation 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 2671-R - was last revised on May 1, 1982. Download an up-to-date fillable PDF version of the DA 2671-R down below or look it up on the Army Publishing Directorate website.

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Download DA Form 2671-R "Certificate of Direct Repatriation for Epw"

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CERTIFICATE FOR DIRECT REPATRIATION FOR EPW
For use of this form, see AR 190-8; the proponent agency is PMG.
FROM:
TO:
The undersigned make up the medical command of a US general hospital. They have examined the EPW named herein and have agreed
that he/she is eligible for repatriation according to the medical agreement in the GPW of 1949.
(Last, first, MI)
NAME
GRADE
SERVICE NUMBER
INTERNMENT SERIAL NUMBER
DATE OF BIRTH
STATUS
MEDICAL:
LITTER
AMBULANT
SURGICAL:
LOCKED WARD
OPEN
ISOLATION
NEUROPSYCHIATRIC
FINAL DIAGNOSIS
PLACE OF EXAMINATION
DATE
TYPED NAME OF COMMANDING OFFICER
SIGNATURE
TYPED NAME OF EXECUTIVE OFFICER
SIGNATURE
TYPED NAME OF CHIEF OF SERVICE
SIGNATURE
DA FORM 2671-R, MAY 1982
APD LC v1.01ES
EDITION OF 1 JUL 63 IS OBSOLETE.
CERTIFICATE FOR DIRECT REPATRIATION FOR EPW
For use of this form, see AR 190-8; the proponent agency is PMG.
FROM:
TO:
The undersigned make up the medical command of a US general hospital. They have examined the EPW named herein and have agreed
that he/she is eligible for repatriation according to the medical agreement in the GPW of 1949.
(Last, first, MI)
NAME
GRADE
SERVICE NUMBER
INTERNMENT SERIAL NUMBER
DATE OF BIRTH
STATUS
MEDICAL:
LITTER
AMBULANT
SURGICAL:
LOCKED WARD
OPEN
ISOLATION
NEUROPSYCHIATRIC
FINAL DIAGNOSIS
PLACE OF EXAMINATION
DATE
TYPED NAME OF COMMANDING OFFICER
SIGNATURE
TYPED NAME OF EXECUTIVE OFFICER
SIGNATURE
TYPED NAME OF CHIEF OF SERVICE
SIGNATURE
DA FORM 2671-R, MAY 1982
APD LC v1.01ES
EDITION OF 1 JUL 63 IS OBSOLETE.
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