Report of Medical Examination. (a) Items 1 through 15 may be completed by initiating unit personnel. (b) Optional items: 44 through 50, 56, 58 through 72, 76, 81. (c) Items 17, 82, leave blank. (d) All items must be completed and signed by medical officer and/or private physician.
Report of Medical History. (a) Initiating unit personnel may complete items 1 through 7. (b) Applicant will complete item 8 through 24 with signature of examinee. (c) Item 25 to be completed by medical officer and/or private physician. Physician's signature required at end of report.