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SF Physical
SPECIAL FORCES PHYSICAL EXAM CHECKLIST
LNAME_______________ L4 SSN____________ CLASS/YG_______ STN_____
BLOCK# DD FORM 2808 PAGES 1-3 REPORT OF MEDICAL EXAMINATION
1-15b ______________ Personal / General Information
15c ______________ PURPOSE OF EXAM ( SF/ SFAS/ SFQC)
16 ______________ NAME OF EXAM LOCATION CLINIC ETC
17-44 ______________ CLINICAL EVALUATION (Any Abnormalities must be explained)
43 ______________ DENTAL (Must Be Acceptable, Class 1 or 2)
45 ______________ URINALYSIS (MUST BE < THAN 2.00 SPECIFY GRAVITY)
45a ______________ ALBUMIN (negative or trace only)
45b ______________ SUGAR (NEGATIVE ONLY)
48 ______________ BLOOD TYPE
49 ______________ HIV (NEGATIVE)
52 ______________ OTHER (SICKLE, RPR, EKG, CHEST X-RAY)
53-55 _____________ HEIGHT/ WEIGHT (If over max weight include tape test)
57 ______________ PULSE (not over 100) 58a-c ______________ BLOOD PRESSURE (MAX’s 140/90 MIN’s 90/60) If High or low need 5dy BP Check
59 ______________VIVID RED/GREEN PASS (Required if fails normal color test in item# 66)
61 ______________ FAR VISION (Must Correct to 20/20 in both eyes)
62 ______________ REFRACTION (Required if uncorrected vision is not 20/20; +or-8 diopters max)
63 ______________ NEAR VISION (Must correct to 20/20 in both eyes)
66 ______________ COLOR VISION (If fails color vision test must be able to pass Vivid Red/Green test)
71a ______________ HEARING(500-2000 Average less than 30db, 3000-45db 4000-55db)
72b ______________ VALSALVA (should be SAT OR +)
73 ______________ NOTES ( Should include here or somewhere on physical – No Fear Statement, Digital Rectal exam or Hemmocult/occult Blood, Chest Xray, EKG)
74a ______________ QUALIFIED/NOT QUALIFIED(MUST STATE SF / SFAS TRAINING)
75b ______________ PHYSICAL PROFILE AND CATEGORY (MIN 111121)
81-84a/b ______________ DOCTOR (MD) & DENTIST (DC or DDS) / Name/Signature
BLOCK DD FORM 2807 1-3 REPORT OF MEDICAL HISTORY
1-9 ______________ EXAMINEE INFORMATION
10-28 ______________ EMAMINEE HISTORY
29 ______________ALL YES ANSWERS MUST BE FULLY EXPLAINED BY EXAMINEE
30 _______________All YES ANSWERS MUST BE EXPLAINED BY PA OR DR
30b ______________ DOCTOR/PA SIGNATURE AND DATE
All Lab results should be annotated on DD 2808 – Retain copy of lab printout in Residual file but do not scan in with physical
Chest X-ray – Should be annotated on DD 2808 as Normal - Retain copy of lab printout in Residual file but do not scan in with physical
EKG/ECG – Should be annotated on DD 2808 as Normal- Retain copy of lab printout in Residual file but do not scan in with physical
Physical QC’d BY: __________________________________________________ _______
Name of Recruiter/Station Cmdr
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