Download DA Form 7349 Initial Medical Review - Annual Medical Certificate
How to Fill out DA Form 7349?
An overview of the form and filing guidelines can be found in the Army Regulation 40-501, Standards of Medical Fitness, released in June 2017. DA Form 7349 instructions are as follows:
- Part I is completed by the soldier. It contains a questionnaire with six yes-or-no questions that have to be answered by the soldier themselves.
- Each positive answer requires a further explanation in Box 8. The soldier has to list all medications they are currently taking in Box 7.
- Failure to provide full information might lead to difficulties in receiving comprehensive health care, but care will not be denied either way.
- The bottom lines of the page require identifying information. This includes the service member's printed name and DoD ID, their rank or grade, MOS, a signature and the date of filing the form.
- Part II is filed by the initial reviewer. This part contains the initial notes of the examination. The reviewer has to decide whether the Soldier is medically ready for duty or requires a further evaluation. This part of the form requires the date of the review and the signature of the reviewer in Boxes 16 and 17.
- Part III is filled in by a physician. All comments are listed in Box 18 and the results of the soldiers readiness evaluation is provided in Box 19. The physician must complete Box 20 with the PULHES using the Physical Profile Functional Capacity Guide in Table 7-1 of AR 40-501. Box 21 specifies whether the Army Physical Profile (DA Form 3349) is attached to the submitted certificate.
PULHES stands for general physical condition, the upper and lower limbs condition, hearing, sight, and physiatric condition.
- Part IV is filled by the approving authorities and requires a recommendation based on the results of the examination along with the date and signature of the authorized official.