DD Form 2492 DoD Medical Examination Review Board (Dodmerb) Report of Medical History

How to Fill Out DD Form 2492?

Completed forms must be mailed to DoDMERB/DR at 8034 Edgerton Drive, Suite 132, USAF Academy, CO 80840-2200. DD Form 2492 instructions are as follows:

1. Items 1 through 3 require the name, Social Security Number and phone number of the applicant;

2. Item 4 requires identifying the purpose of the examination. The name of the examination facility or the name of the examiner along with their full address with ZIP code are entered in Item 5. The date of the examination is specified in Item 6;

3. The main block of the form is a 75-part questionnaire that requires information about past substance abuse, chronic illnesses, surgeries and any sexually transmitted diseases the applicant may have:

   • Questions 79 through 82 are for female applicants only. Authorized officials may request the applicant's medical records to further clarify their medical history. Any positive answers to questions 7 through 81 have to be explained in Item 83;
   • All explanations should be detailed and include specific dates, physicians' names, the names of hospitals or clinics, and the current health status. If the provided space is not enough, the applicant may attach a copy of the DD Form 2492 as an additional sheet to the form.

4. Item 84 contains a pre-printed certification and a boxe for the applicant to sign;

5. Item 85 is completed by the examiner. The box requires their comments on the applicant's answers and actual medical history;

6. The examiner has to provide their name, date, and signature in the corresponding boxes in Item 86 to certify their statement;

7. Item 87 requires specifying the total number of sheets attached to the form.