Free Army Medical Checklist Template
Army Medical Checklist
Soldier Information:
|
Item |
Information |
|---|---|
|
Soldier Name |
Marcelo Green |
|
Date of Birth |
January 15, 1995 |
|
Soldier ID |
1234567890 |
|
Contact Email |
marcelo@you.mail |
Pre-Deployment Health Assessment
Physical Health
-
Vision: Pass/fail on vision test
-
Hearing: Pass/fail on hearing test
-
Blood Pressure: Less than 140/90 mmHg
-
Height & Weight: Within military standards
-
Fitness Test: Successful completion of physical fitness test
Immunizations & Medical History
|
Immunization or Test |
Status |
|---|---|
|
Hepatitis B |
Up-to-date?
|
|
Tetanus & Diphtheria |
Up-to-date?
|
|
Influenza |
Up-to-date?
|
|
Malaria Prophylaxis |
Required for deployment |
|
TB Skin Test |
Negative |
Mental Health Evaluation
-
Psychological Screening: Pass/fail mental health evaluation
-
Stress Test: Pass/fail stress response test
-
Counseling: No unresolved mental health issues
-
Substance Abuse: Negative drug test
Medical Clearance for Specialized Roles
|
Role |
Status |
|---|---|
|
Airborne Operations |
Medically cleared?
|
|
Special Forces |
Medically cleared?
|
|
Combat Medic |
Medically cleared?
|
Soldier Confirmation
-
I confirm that the information provided is accurate.
-
I agree to undergo any necessary follow-up evaluations.
Contact Information for Queries
For further inquiries, please contact the medical office at:
[YOUR COMPANY NAME]
Address: [YOUR COMPANY ADDRESS]
Email: [YOUR COMPANY EMAIL]
Phone: [YOUR COMPANY NUMBER]
