What is DA Form 2173?
Form DA 2173, known as the Statement of Medical Examination and Duty Status, is an important document for military personnel. It assesses a Soldier's duty status when they experience an injury or illness. This form plays a vital role in securing the necessary benefits and medical care by recording the Soldier's condition, the timing of the incident, and their military status at that moment. It's essential for processing Line of Duty (LOD) determinations, which affect entitlements and benefits for Soldiers affected while on duty.
What is DA Form 2173 used for?
Form DA 2173 is an important document for military personnel. It serves several key purposes:
- Line of Duty (LOD) Determination: Records injuries or illnesses from military duty to confirm if they occurred in line of duty.
- Medical Readiness: Helps ensure Soldiers get the right benefits and notifications about payments.
- Investigations: Supplies information on a Soldier’s status during injury or death, aiding formal LOD investigations.
How to fill out DA Form 2173?
- 1
Fill out blocks 1-8 as the Soldier.
- 2
Ensure blocks 9-24 are completed by the Attending Physician or Hospital Patient Administrator.
- 3
Receive the completed form and medical documentation from the physician.
- 4
Provide the unit representative or commander with the DA Form 2173 and medical documents.
- 5
Confirm that the unit representative uploads the signed form into the eMMPS.
- 6
Check blocks 25-41 are filled out by the commander or SARC, and block 39 is signed.
- 7
Refer to official sources to verify any latest signature requirements.
Who is required to fill out DA Form 2173?
DA Form 2173 is completed by the Attending Physician, Hospital Patient Administrator, or Unit Administrator/Readiness. They fill out blocks 9 through 24, providing essential medical information and duty status.
Once finished, the form is returned to the Soldier with medical documentation. The immediate commander or SARC then completes blocks 25 through 41 and submits the signed form for processing at the National Guard Bureau.
When is DA Form 2173 not required?
The DA Form 2173 is not required for Reserve Component Soldiers with more than 30 days of active duty. These soldiers do not require a line of duty investigation and are authorized care without the need for a DA Form 2173. Additionally, the for is unnecessary in case of non-emergency injuries or illnesses that do not require medical evaluation.
When is DA Form 2173 due?
For non-emergency care, soldiers must report a condition incurred or aggravated while on military duty status within 180 days after release from active duty (AD) or inactive duty for training (IDT).
How to get a blank DA Form 2173?
To access a blank Form DA 2173, issued by the Department of the Army as per AR 600-8-4, simply visit our website. PDF Guru helps you fill and download the form, but remember, we do not assist with filing forms.
How to sign DA Form 2173?
To complete DA Form 2173, ensure you include a valid handwritten signature, as electronic signatures are not accepted. After filling out the necessary fields in our PDF editor, download the completed form for your records. Remember to check for the latest updates regarding signature requirements and submission processes, as PDF Guru does not support form submission.
Where to file DA Form 2173?
To submit Form DA 2173, first ensure that all required fields, including medical documentation and duty status information, are accurately filled out.
Next, have your unit representative upload the signed form and any additional documents into the electronic Medical Management Processing System (eMMPS). If electronic submission is not possible, mailing the documents remains an option.
