DA Form 3947-1 "Medical Evaluation Board Proceedings"

What Is DA Form 3947-1?

This is a military form that was released by the U.S. Department of the Army (DA) on June 1, 2017. The form, often mistakenly referred to as the DD Form 3947-1, 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;
  • Editable, free, and easy to use;

Download an up-to-date fillable DA Form 3947-1 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 3947-1 "Medical Evaluation Board Proceedings"

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DATE
MEDICAL EVALUATION BOARD PROCEEDINGS
Page
of
For use of this form, see AR 635-40 and DA Form 3947 instructions; the proponent agency is DCS, G-1.
1. NAME (Last, First, MI)
2. PAY GRADE
3. SSN
4. DOD ID NUMBER
ACTION BY THE BOARD
BY DIRECTION OF THE APPOINTING AUTHORITY, THE BOARD CONVENED TO EVALUATE THE SERVICE MEMBER IDENTIFIED ABOVE.
11. DIAGNOSIS
a.
b.
c.
d.
e.
AFTER CONSIDERATION OF THE CASE FILE (INCLUDING ALL AVAILABLE
APPROXIMATE DATE
MEETS
EXISTED
OF ORIGIN
AR 40-501
PRIOR TO
CLINICAL RECORDS, LABORATORY FINDINGS, AND PHYSICAL EXAMINATIONS)
RETENTION
SERVICE
THE BOARD FINDS THAT THE SERVICE MEMBER HAS THE FOLLOWING
STANDARD
DIAGNOSED MEDICAL CONDITIONS.
NOTE: IF IDES, ALL CURRENT DIAGNOSES CONFIRMED BY THE VA MEDICAL
DOES
EXAMINATION MUST BE LISTED.
MEETS
NOT
YES
NO
YES
NO
MEET
APD LC v1.00
DA FORM 3947-1, JUN 2017
DATE
MEDICAL EVALUATION BOARD PROCEEDINGS
Page
of
For use of this form, see AR 635-40 and DA Form 3947 instructions; the proponent agency is DCS, G-1.
1. NAME (Last, First, MI)
2. PAY GRADE
3. SSN
4. DOD ID NUMBER
ACTION BY THE BOARD
BY DIRECTION OF THE APPOINTING AUTHORITY, THE BOARD CONVENED TO EVALUATE THE SERVICE MEMBER IDENTIFIED ABOVE.
11. DIAGNOSIS
a.
b.
c.
d.
e.
AFTER CONSIDERATION OF THE CASE FILE (INCLUDING ALL AVAILABLE
APPROXIMATE DATE
MEETS
EXISTED
OF ORIGIN
AR 40-501
PRIOR TO
CLINICAL RECORDS, LABORATORY FINDINGS, AND PHYSICAL EXAMINATIONS)
RETENTION
SERVICE
THE BOARD FINDS THAT THE SERVICE MEMBER HAS THE FOLLOWING
STANDARD
DIAGNOSED MEDICAL CONDITIONS.
NOTE: IF IDES, ALL CURRENT DIAGNOSES CONFIRMED BY THE VA MEDICAL
DOES
EXAMINATION MUST BE LISTED.
MEETS
NOT
YES
NO
YES
NO
MEET
APD LC v1.00
DA FORM 3947-1, JUN 2017