Use this stepbystep guide to complete the af form 348 quickly and with ideal accuracy. The way to complete the online af form 348 on the internet. Jun 04, 2018 if there is a medical clinic on base or if you have to go to urgent car from a civilian provider make sure you carry with you a line of duty form 2173 and have the doctor to fill out section 2 this form is a must. Appeals and revision or correction of line of duty findings. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly no software. Nov 01, 2014 27 once the appointing authoritythe spcmcareceives the da form 2173, he will appoint an investigating officer io to complete department of defense dd form 261, report of investigation line of duty and misconduct status, 28 after the 10 completes the report, the spcmca will ensure the ios report complies with his instructions. Line of duty lod dental care utilizing the active duty.
If there is a medical clinic on base or if you have to go to urgent car from a civilian provider make sure you carry with you a line of duty form 2173 and have the doctor to fill out section 2 this form is a must. Fillable dd form 350 printable, blank pdf and instructions formsbank. It implements titles 5, 10, and 32, united states code. The unit uploads the signed da 2173, medical documents, orders or drill roster within the electronic lod module emmps. Fill out the duty roster online and print it out for free. It contains standardized training objectives, in the form of task summaries, to train and evaluate soldiers on critical tasks that support unit missions during wartime.
You just need to follow these elementary guidelines. Line of duty lod dental care utilizing the active duty dental program addp purpose. Line of duty care you may qualify for line of duty care if you incur or aggravate an injury, illness, or disease while in the line of duty performing adt, idt, drill weekend, or any other training while on orders. Trainers and first line supervisors should ensure soldiers holding mossl 91g12345 have access to this publication. This form is used during line of duty investigations ldi in cases when a soldier received an injury, illness or disease during. The service member may appeal, in writing within 30 days after. Dd form 261, report of investigation line of duty and misconduct status completed. Use this stepbystep guide to fill out the form dr 2173 quickly and with ideal precision. Oct 9, 2018 printable da form 2173 statement of medical examination and duty status. The latest version of the form was released by the department of the army da in october 1972. The unit commander then completes blocks 19 thru 34, signs in block 35 and ensures it is uploaded into the emmps.
Army publications, pdf forms fillable savable, pdf forms fillable, pdf forms saveable, pdf forms savable, eforms, eforms, pdf forms, adobe acrobat forms created date. Da form 2173, statement of medical examination and duty status is a form used during line of duty investigations ldi in cases when a soldier receives an injury, illness or disease during active duty service, inactive idt and active duty ad training or traveling to and from idtad. Members remaining on active duty while incapacitated will receive their active duty pay and allowances instead of incapacitation pay. They will only receive incapacitation pay upon release from active duty. Find the form you need or information about filing a claim. View, download and print da 2173 statement of medical examination and duty status, oct 1972 pdf template or form online. Line of duty determinations a line of duty lod determination is an administrative tool for determining a members duty status at the time an injury, illness, disability, or death is incurred. The addp is available for service members on active duty for greater than 30 days. Direct service connection may be granted only when a disability or cause of death was incurred or aggravated in line of duty, and not the result of the veteran s own willful misconduct or, for claims filed after october 31, 1990, the result of his or her abuse of alcohol or drugs.
This form is used during line of duty investigations ldi in cases when a soldier received an injury, illness or disease during active duty, inactiveduty training or traveling to and. Supply and deliver light duty automotive parts request for quote no. Da form 2173 one page with all required signatures air force. Section iiof da form 2173 will be completed by the unit commander or unit. Line of duty policy, procedures, and investigations. When an informal investigation is not completed within the given time, the reasons the report is late should be included in the remarks section of da form 2173 statement of medical examination and duty status. The definition of line of duty in this regulation is confined to the. Absence without authority materially interferred with the performance of military duty explain in item 30 type of duty missed, hours of duty, and how it did or did not interfere with performance 19 duty station a. Da form 2173, statement of medical examination and duty status patient affairs branch figure 33. If the circumstance surrounding the wound, injury, illness, or disease requires a formal lod investigation, then do form 261 report of investigation line of duty and misconduct status must be submitted prior to processing the packet. The defense health agencygreat lakes formerly known as the military medical support office dhagl assists with the coordination medical care for remotelylocated active duty and reserve component service members in the united states and district of columbia through tricare prime remote and the supplemental health care program.
Fill da form 2173, download blank or editable online. Appeals and revision or correction of line of duty. Injury is considered to have been incurred in line of duty not applicable on deaths 34. If a not in the line of duty determination is made, the service member will not be reimbursed for cost associated with this injuryillness or disease. Line of duty lod dental care utilizing the active duty dental. Section ii of da form 2173 will be completed by the unit commander or unit. Da form 2173 statement of medical examination and duty status printable. Oct 17, 2019 find the form you need or information about filing a claim. Direct service connection may be granted only when a disability or cause of death was incurred or aggravated in line of duty, and not the result of the veterans own willful misconduct or, for claims filed after october 31, 1990, the result of his or her abuse of alcohol or drugs. The latest version of the form was released by the. Authors administrative and civil law division, ti ag sa 7.
The latest fillable version of the form can be downloaded below. View army line of duty da form 2173 ppts online, safely and virusfree. It does not matter how far the civilian facility is away from your duty location. Dr 2173 pdf fill out and sign printable pdf template. Mos 91g and for trainers and firstline supervisors. Co dor dr 2173 2014 fill out tax template online us. Co dor dr 2173 is not the easiest one, but you have no reason for worry in any case. Da form 2173 one page with all required signatures. The soldier provides the commander with the da 2173 and medical documentation. Da form 2173, statement of medical examination and duty status is a form used during line of duty investigations ldi in cases when a soldier receives an. Da form 2173 statement of medical examination and duty. The way to complete the online dr 2173 pdf on the internet.
Da form 6 download fillable pdf or fill online duty roster. Af form 348 fill out and sign printable pdf template. Browse our forms library for documentation on various topics like enrollment, pharmacy, dental, and more. This includes when traveling directly to or from your place of duty. However, the line of duty notice of eligibility noe for u. Coast guard members determination process for dental care is. The timeline for completing an informal investigation is no more than 60 days. Da form 2173 download printable pdf or fill online statement of. Da form 2173 statement of medical examination and duty status. The line of duty investigation process, page 5 section i informal line of duty investigations, page 5 general 31, page 5 da form 2173 32, page 5 evidence collection 33, page 5 line of duty determination 34, page 5 forwarding investigation 35, page 6 actions by appointingapproval authority 36, page 6. The advanced tools of the editor will guide you through the editable pdf template. Da form 2173, statement of medical examinations and duty status, must be completed. Performing organization report number the judge advocate generals school, army charlottesville, va 229031781 ja 23192 9.
Mrp2adme process wtc for approval via the active duty. It takes precedence o ver all other publications relating to line of duty. Sign up to receive tricare updates and news releases via email. Download fillable da form 6 in pdf the latest version applicable for 2020. Af form 348 two pages with all required signatures. Trainers and firstline supervisors should ensure soldiers holding mossl 91g12345 have access to this publication. To get line of duty care, your unit must issue a line of duty lod determination or a notice of eligibility. Mos 91g and for trainers and first line supervisors. The city is inviting quotes for the supply and delivery of light duty automotive parts on an as, and when required basis. If you need to file a claim yourself, you can access medical, pharmacy, and dental claim forms here. Co dor dr 2173 2014 fill out tax template online us legal.
A letter signed by the commander must accompany the dmna form 40er along with copies of the prescriptions, a statement of medical examination and duty status da form 2173 and the. Download da form 2173, statement of medical examination and duty status to conduct line of duty investigations within the us army in cases of injury or illness. Soldiers who contract or aggravate an injury, illness, or disease while in the line of duty, during inactive duty, active duty, or travel to and from such duty are authorized military medical treatment for those conditions. Sep 26, 2019 case that facility will complete section i of da form 2173. Statement of medical examination and duty status for use of this form see ar 60084 the proponent agency is. This form is used during line of duty investigations ldi in cases when a soldier received an injury, illness or disease during active duty, inactive duty training or traveling to and from idt.
Statement of medical examination and duty status keywords. Using our convenient service you will see how to fill co dor dr 2173 in situations of critical time deficit. Mrp2adme process wtc for approval via the active duty order. On the basis of the lod determination, the member may be entitled to benefits administered by the air force, or exposed to liabilities. For use of this form, see ar 60084, the proponent agency is dcs, g1. Da form 2173 statement of medical examination and duty status lod determination and approval letter. Da form 2173, statement of medical examination and duty status is used in cases of either a formal or an informal line of duty lod determination process. Da form 2173 fill online, printable, fillable, blank. The purpose of this guide is to assist officers who have been appointed to serve as line of duty investigating officers under the provisions of ar 60084. I was told the line of duty da form 2173 cant be changed. Dd form 261, report of investigationline of duty and misconduct status completed. Printable da form 2173 statement of medical examination and. Af form 348 fill out and sign printable pdf template signnow.
Da form 2173, statement of medical examination and duty status. Printable da form 2173 statement of medical examination. This treatment will continue until the problem is resolved or. Reports of survey and line of duty determinations na 6. A line of duty lod determination is an administrative tool for determining a. Dd form 261, report of investigation line of duty and. Da form 6 is often used in united states army, army forms, business, united states federal legal forms and united states legal forms.
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