AF IMT Form 1418 "Recommendation for Flying or Special Operational Duty - Dental"

What Is AF IMT Form 1418?

This is a legal form that was released by the U.S. Air Force IMT (Information Management Tool) on December 13, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 13, 2017;
  • The latest available edition released by the U.S. Air Force IMT (Information Management Tool);
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;

Download a fillable version of AF IMT Form 1418 by clicking the link below or browse more documents and templates provided by the U.S. Air Force IMT (Information Management Tool).

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Download AF IMT Form 1418 "Recommendation for Flying or Special Operational Duty - Dental"

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RECOMMENDATION FOR FLYING OR SPECIAL OPERATIONAL DUTY - DENTAL
(THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974 - Use blanket PAS - DD Form 2005)
TO:
FROM:
DATE/TIME OF TREATMENT
NAME (Last, First, Middle Initial)
GRADE
SSN
ORGANIZATION
DIAGNOSIS
TREATMENT
MEDICATION ADMINISTERED
MEDICATION PRESCRIBED
Local anesthesia:
YES
NO
Other:
RECOMMEND NO PARTICIPATION IN FLYING OR SPECIAL OPERATIONAL DUTY FOR
HOURS OR
DAYS.
PATIENT TO RETURN TO CLINIC FOR FOLLOW-UP EVALUATION ON
.
RECOMMEND RETURN TO FLYING OR SPECIAL OPERATIONAL DUTY.
FSO NOTIFIED BY PHONE.
TYPED OR PRINTED NAME AND GRADE OF DENTAL OFFICER
SIGNATURE
DATE
I CERTIFY that i understand the above recommendation.
SIGNATURE OF PATIENT
DATE
AF IMT 1418, 20171213, V2
PREVIOUS EDITIONS ARE OBSOLETE.
Copy 1 - Flight Medicine via Member
RECOMMENDATION FOR FLYING OR SPECIAL OPERATIONAL DUTY - DENTAL
(THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974 - Use blanket PAS - DD Form 2005)
TO:
FROM:
DATE/TIME OF TREATMENT
NAME (Last, First, Middle Initial)
GRADE
SSN
ORGANIZATION
DIAGNOSIS
TREATMENT
MEDICATION ADMINISTERED
MEDICATION PRESCRIBED
Local anesthesia:
YES
NO
Other:
RECOMMEND NO PARTICIPATION IN FLYING OR SPECIAL OPERATIONAL DUTY FOR
HOURS OR
DAYS.
PATIENT TO RETURN TO CLINIC FOR FOLLOW-UP EVALUATION ON
.
RECOMMEND RETURN TO FLYING OR SPECIAL OPERATIONAL DUTY.
FSO NOTIFIED BY PHONE.
TYPED OR PRINTED NAME AND GRADE OF DENTAL OFFICER
SIGNATURE
DATE
I CERTIFY that i understand the above recommendation.
SIGNATURE OF PATIENT
DATE
AF IMT 1418, 20171213, V2
PREVIOUS EDITIONS ARE OBSOLETE.
Copy 1 - Flight Medicine via Member
RECOMMENDATION FOR FLYING OR SPECIAL OPERATIONAL DUTY - DENTAL
(THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974 - Use blanket PAS - DD Form 2005)
TO:
FROM:
DATE/TIME OF TREATMENT
NAME (Last, First, Middle Initial)
GRADE
SSN
ORGANIZATION
DIAGNOSIS
TREATMENT
MEDICATION ADMINISTERED
MEDICATION PRESCRIBED
Local anesthesia:
YES
NO
Other:
RECOMMEND NO PARTICIPATION IN FLYING OR SPECIAL OPERATIONAL DUTY FOR
HOURS OR
DAYS.
PATIENT TO RETURN TO CLINIC FOR FOLLOW-UP EVALUATION ON
.
RECOMMEND RETURN TO FLYING OR SPECIAL OPERATIONAL DUTY.
FSO NOTIFIED BY PHONE.
TYPED OR PRINTED NAME AND GRADE OF DENTAL OFFICER
SIGNATURE
DATE
I CERTIFY that i understand the above recommendation.
SIGNATURE OF PATIENT
DATE
AF IMT 1418, 20171213, V2
PREVIOUS EDITIONS ARE OBSOLETE.
Copy 2 - Flight Medicine via Member
RECOMMENDATION FOR FLYING OR SPECIAL OPERATIONAL DUTY - DENTAL
(THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974 - Use blanket PAS - DD Form 2005)
TO:
FROM:
DATE/TIME OF TREATMENT
NAME (Last, First, Middle Initial)
GRADE
SSN
ORGANIZATION
DIAGNOSIS
TREATMENT
MEDICATION ADMINISTERED
MEDICATION PRESCRIBED
Local anesthesia:
YES
NO
Other:
RECOMMEND NO PARTICIPATION IN FLYING OR SPECIAL OPERATIONAL DUTY FOR
HOURS OR
DAYS.
PATIENT TO RETURN TO CLINIC FOR FOLLOW-UP EVALUATION ON
.
RECOMMEND RETURN TO FLYING OR SPECIAL OPERATIONAL DUTY.
FSO NOTIFIED BY PHONE.
TYPED OR PRINTED NAME AND GRADE OF DENTAL OFFICER
SIGNATURE
DATE
I CERTIFY that i understand the above recommendation.
SIGNATURE OF PATIENT
DATE
AF IMT 1418, 20171213, V2
PREVIOUS EDITIONS ARE OBSOLETE.
Copy 3 - Flight Medicine via Member
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