DA Form 7349 "Initial Medical Review - Annual Medical Certificate"

What Is DA Form 7349?

This is a military form that was released by the U.S. Department of the Army (DA) on June 1, 2019. The form, often mistakenly referred to as the DD Form 7349, 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 2-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 7349 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 7349 "Initial Medical Review - Annual Medical Certificate"

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INITIAL MEDICAL REVIEW - ANNUAL MEDICAL CERTIFICATE
For use of this form, see PAM 40-502; the proponent agency is OTSG.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Authority
Section 133, Title 10, United States Code (10 USC 133).
The primary use of this information is to provide medical information of sufficient detail to ensure uniformity in
Purpose
medical evaluation. Used to evaluate Soldiers in terms of medical conditions and physical defects which may
require medical care or which may require a determination of medical readiness.
The DoD Blanket Routine Uses may apply to this collection.
Routine Uses
The requested information is voluntary because of the need to document all medical incidents in view of future
Disclosure
rights and benefits. If the requested information is not furnished, comprehensive health care may not be
possible, but CARE WILL NOT BE DENIED.
PART I -- COMPLETED BY SOLDIER
YES
NO
Please check the appropriate response column for each question below.
1.
Do you currently have any medical/dental problems?
2.
Have you had any medical or dental problems since your last periodic physical examination?
3.
Have you been seen by or been treated by a dentist, physician, or other health care provider since
your last periodic physical examination?
4.
Have you been hospitalized or had surgery since your last periodic physical examination?
Are you currently taking medication, or have you taken prescription medication since your last
5.
examination?
6.
Are you currently or have you in the past received a VA Disability, Workmen's Compensation, or other
type of compensation for health or physical reason?
7. LIST ANY MEDICATIONS YOU ARE CURRENTLY TAKING
8. EXPLAIN ANY POSITIVE ANSWERS GIVEN ABOVE
I certify that the above information is true and correct to the best of my knowledge. I further understand that false statements
made on this form may be cause for reassignment, discharge, or other disciplinary action.
9. DoD ID NUMBER
10. RANK/GRADE
11. MOS
12. DATE
13a. PRINTED/TYPED NAME
13b. SIGNATURE
PREVIOUS EDITIONS ARE OBSOLETE.
Page 1 of 2
DA FORM 7349, JUN 2019
APD AEM v1.00ES
INITIAL MEDICAL REVIEW - ANNUAL MEDICAL CERTIFICATE
For use of this form, see PAM 40-502; the proponent agency is OTSG.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Authority
Section 133, Title 10, United States Code (10 USC 133).
The primary use of this information is to provide medical information of sufficient detail to ensure uniformity in
Purpose
medical evaluation. Used to evaluate Soldiers in terms of medical conditions and physical defects which may
require medical care or which may require a determination of medical readiness.
The DoD Blanket Routine Uses may apply to this collection.
Routine Uses
The requested information is voluntary because of the need to document all medical incidents in view of future
Disclosure
rights and benefits. If the requested information is not furnished, comprehensive health care may not be
possible, but CARE WILL NOT BE DENIED.
PART I -- COMPLETED BY SOLDIER
YES
NO
Please check the appropriate response column for each question below.
1.
Do you currently have any medical/dental problems?
2.
Have you had any medical or dental problems since your last periodic physical examination?
3.
Have you been seen by or been treated by a dentist, physician, or other health care provider since
your last periodic physical examination?
4.
Have you been hospitalized or had surgery since your last periodic physical examination?
Are you currently taking medication, or have you taken prescription medication since your last
5.
examination?
6.
Are you currently or have you in the past received a VA Disability, Workmen's Compensation, or other
type of compensation for health or physical reason?
7. LIST ANY MEDICATIONS YOU ARE CURRENTLY TAKING
8. EXPLAIN ANY POSITIVE ANSWERS GIVEN ABOVE
I certify that the above information is true and correct to the best of my knowledge. I further understand that false statements
made on this form may be cause for reassignment, discharge, or other disciplinary action.
9. DoD ID NUMBER
10. RANK/GRADE
11. MOS
12. DATE
13a. PRINTED/TYPED NAME
13b. SIGNATURE
PREVIOUS EDITIONS ARE OBSOLETE.
Page 1 of 2
DA FORM 7349, JUN 2019
APD AEM v1.00ES
PART II -- COMPLETED BY INITIAL REVIEWER
14. INITIAL REVIEWER'S NOTES
15.
16. SIGNATURE
17. DATE
MEDICALLY
REQUIRES
READY
FURTHER
EVALUATION
PART III -- COMPLETED BY PHYSICIAN
18. PHYSICIAN'S REVIEW NOTES
19.
20. Complete "PULHES" using the
MEDICALLY
NOT MEDICALLY
NOT MEDICALLY
P
L
H
E
U
S
Physical Profile Functional
READY
READY (USAR
READY (Army National
Capacity Guide in Table 7-1,
refer to para 9-10 &
Guard refer to MDRB)
AR 40-501.
9-11 AR 40-501)
21. DA FORM 3349 IS ATTACHED
22. SIGNATURE
23. DATE
YES
NO
PART IV -- COMPLETED BY APPROVING AUTHORITY
24. MISCELLANEOUS RECOMMENDATIONS
26. DATE
25. SIGNATURE
DA FORM 7349, JUN 2019
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APD AEM v1.00ES
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