DD Form 2489 DoD Medical Examination Review Board (Dodmerb) Farnsworth Lantern and Red/Green Color Vision Tests

DD Form 2489 or the "Farnsworth Lantern And Red/green Color Vision Tests" is a Department of Defense-issued form used by and within the United States Army.

The form - often mistakenly referred to as the DA form 2489 - was last revised on March 1, 2008. Download an up-to-date fillable PDF version of the DD 2489 down below or find it on the Department of Defense documentation website.

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DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB)
OMB No. 0704-0396
FARNSWORTH LANTERN AND
OMB approval expires
RED/GREEN COLOR VISION TESTS
Nov 30, 2009
The public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate, Information Management Division, 1155 Defense Pentagon, Washington, DC 20301-1155
(0704-0396). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not
display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO DODMERB/DR, 8034 EDGERTON
DRIVE, SUITE 132, USAF ACADEMY CO 80840-2200.
PRIVACY ACT STATEMENT
AUTHORITY: Title 10, USC 133, 3012, 5031, 8013, and Executive Order 9397.
PRINCIPAL PURPOSE: To determine medical acceptability or update a medical file as part of the application process to a United States
Service Academy, Reserve Officer Training Corps (ROTC) Scholarship Program, or the Uniformed Services University of the Health Sciences
(USUHS).
ROUTINE USES: This information may be disclosed to the Coast Guard Academy and Merchant Marine Academy for applications to their
Academies.
DISCLOSURE: Voluntary; however, failure to furnish the requested information will impede the selection process and hamper your candidacy.
Use of the Social Security Number (SSN) is used for positive identification of records.
1. NAME OF APPLICANT (Last, First, Middle Initial)
2. SOCIAL SECURITY NUMBER
FARNSWORTH LANTERN
IMPORTANT: This test MUST be performed or verified and countersigned by an optometrist, flight surgeon,
or by a physician experienced in performing the FALANT test.
INSTRUCTIONS TO EXAMINERS
READ REVERSE SIDE OF THIS FORM BEFORE ADMINISTERING TEST.
Indicate by letter the applicants' responses,
reminding them at the beginning of the test that there are only three responses: Red, Green, or White.
NUMBER OF
G/R
W/G
G/W
G/G
R/G
W/R
W/W
R/W
R/R
ERRORS PER RUN
1st RUN
2nd RUN
3rd RUN
NOTES: Farnsworth Dichotomous or other variations are not acceptable.
The examiner must alter the sequence of lights on the 2nd and 3rd runs.
RED/GREEN COLOR VISION TEST
3. I CERTIFY THAT APPLICANT
CAN
CANNOT
DISTINGUISH AND IDENTIFY OBJECTS THAT ARE BRIGHT RED AND BRIGHT GREEN.
5. FACILITY NAME AND COMPLETE
4. EXAMINER
ADDRESS (Street, City, State, ZIP Code)
NAME (Last, First, Middle Initial)
TITLE
EXAMINER SIGNATURE
DATE
PHYSICIAN SIGNATURE
DATE
(YYYYMMDD)
(YYYYMMDD)
DD FORM 2489, MAR 2008
PREVIOUS EDITION IS OBSOLETE.
Reset
Adobe Professional 7.0
DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB)
OMB No. 0704-0396
FARNSWORTH LANTERN AND
OMB approval expires
RED/GREEN COLOR VISION TESTS
Nov 30, 2009
The public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate, Information Management Division, 1155 Defense Pentagon, Washington, DC 20301-1155
(0704-0396). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not
display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO DODMERB/DR, 8034 EDGERTON
DRIVE, SUITE 132, USAF ACADEMY CO 80840-2200.
PRIVACY ACT STATEMENT
AUTHORITY: Title 10, USC 133, 3012, 5031, 8013, and Executive Order 9397.
PRINCIPAL PURPOSE: To determine medical acceptability or update a medical file as part of the application process to a United States
Service Academy, Reserve Officer Training Corps (ROTC) Scholarship Program, or the Uniformed Services University of the Health Sciences
(USUHS).
ROUTINE USES: This information may be disclosed to the Coast Guard Academy and Merchant Marine Academy for applications to their
Academies.
DISCLOSURE: Voluntary; however, failure to furnish the requested information will impede the selection process and hamper your candidacy.
Use of the Social Security Number (SSN) is used for positive identification of records.
1. NAME OF APPLICANT (Last, First, Middle Initial)
2. SOCIAL SECURITY NUMBER
FARNSWORTH LANTERN
IMPORTANT: This test MUST be performed or verified and countersigned by an optometrist, flight surgeon,
or by a physician experienced in performing the FALANT test.
INSTRUCTIONS TO EXAMINERS
READ REVERSE SIDE OF THIS FORM BEFORE ADMINISTERING TEST.
Indicate by letter the applicants' responses,
reminding them at the beginning of the test that there are only three responses: Red, Green, or White.
NUMBER OF
G/R
W/G
G/W
G/G
R/G
W/R
W/W
R/W
R/R
ERRORS PER RUN
1st RUN
2nd RUN
3rd RUN
NOTES: Farnsworth Dichotomous or other variations are not acceptable.
The examiner must alter the sequence of lights on the 2nd and 3rd runs.
RED/GREEN COLOR VISION TEST
3. I CERTIFY THAT APPLICANT
CAN
CANNOT
DISTINGUISH AND IDENTIFY OBJECTS THAT ARE BRIGHT RED AND BRIGHT GREEN.
5. FACILITY NAME AND COMPLETE
4. EXAMINER
ADDRESS (Street, City, State, ZIP Code)
NAME (Last, First, Middle Initial)
TITLE
EXAMINER SIGNATURE
DATE
PHYSICIAN SIGNATURE
DATE
(YYYYMMDD)
(YYYYMMDD)
DD FORM 2489, MAR 2008
PREVIOUS EDITION IS OBSOLETE.
Reset
Adobe Professional 7.0
FARNSWORTH LANTERN AND RED/GREEN COLOR VISION TESTS - INSTRUCTIONS
PREPARATION FOR TESTING
1. Give the test in a normally lighted room; screen
3. Station examinee eight feet from lantern.
from glare; exclude sunlight. Examinee should not
face the source of room illumination.
4. If examinee ordinarily wears contact lenses or
glasses for distance, they should be worn. Color
2. Only one person should be tested at a time.
correcting lenses, if worn, must be removed prior to
(Others shall not be allowed to watch.)
testing.
ADMINISTRATION AND SCORING
1. Instruct examinee," The lights you will see in this
6. Average the errors of these last two runs. If an
lantern are either red, green, or white. They look like
average of more than one error per run is made,
signal lights at a distance. Two lights are presented at
examinee is failed. If an average of one, or less than
a time - in any combination. Call out the colors as
one error per run is made, examinee is passed.
soon as you see them, naming first the color at the top
and then the color at the bottom. Remember, only
7. An error is considered the miscalling of one or both
three colors - red, green, and white. Name which light
of a pair of lights; if an examinee changes his/her
color combination exists, top one first."
response before the next light is presented, record the
second response only.
2. Turn knob at top of lantern to charge lights;
depress button in center of knob to expose lights.
Maintain regular timing of about two seconds per light.
8. If an examinee says "yellow," "pink," etc., you
should say, "There are only three colors - red, green,
3. Expose the lights in random order starting with a
and white."
R/G or G/R combination, continuing until each of the
nine combinations has been exposed.
9. If an examinee takes over 3 seconds to respond,
you should say, "As soon as you see the lights, call
4. If no errors are made on this first run of nine pairs
them."
of lights, examinee is passed.
10. Do not discuss passing/failing scores with
5. If any errors are made on this first run, give two
applicant. Under no circumstances will an applicant
more complete runs.
receive more than 3 total runs.
6. REMARKS (Attach additional pages if necessary.)
DD FORM 2489 (BACK), MAR 2008
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