Blank Da 4036 Template

What is the purpose of the DA Form 4036?

The DA Form 4036 is designed to prepare Service members and their families for overseas movement. It helps to verify that everyone meets the necessary medical and dental standards required for such assignments. This form ensures that any health issues are identified before departure, minimizing complications once abroad.

Who is required to fill out the DA Form 4036?

All soldiers being reassigned to overseas locations must complete this form. Additionally, family members who will accompany the soldier are also required to undergo medical and dental evaluations, as indicated within the form. Their participation is crucial to ensuring their health needs are adequately addressed while overseas.

What happens if family members refuse to participate in the evaluation?

If family members choose not to complete the necessary medical and dental evaluations, they will not be permitted to accompany the soldier on the overseas assignment. It is essential to comply with these requirements to ensure safe relocation for the entire family.

What information is collected on the DA Form 4036?

The form collects various personal details, including the soldier's name, Social Security Number (SSN), rank, current and projected units of assignment, and medical and dental status. The information helps military personnel assess the suitability of Service members and their families for overseas assignments.

How is personal information on the form protected?

The DA Form 4036 includes a Privacy Act Statement that outlines how the information will be used and safeguarded. Disclosure of the information is voluntary, but it is crucial for processing overseas assignments. Therefore, it is handled with confidentiality and care to protect the privacy of all individuals involved.

What are the consequences if the medical condition of a soldier or family member is not reported?

Failing to report medical conditions can lead to significant risks for the soldier and their family while stationed overseas. If health issues not disclosed later surface, they could jeopardize the assignment and the well-being of the individuals involved. The military aims to provide adequate care and facilities to those who accurately report their status.

What should soldiers do if they have a temporary medical condition?

If a soldier has a temporary medical condition, they should still report it on the form. They must provide information about the expected duration, and any limitations that might affect their assignment. This transparency allows military medical staff to make informed decisions about the individual’s suitability for service in specific assignments.

Are there any specific immunizations required for overseas assignments?

Yes, certain assignments, especially those to specific locations like Korea, may require special immunizations, such as the hepatitis B vaccine. The DA Form 4036 asks soldiers about their immunization status to ensure they are adequately protected before their assignment.

What should soldiers do if they need follow-up evaluations?

For soldiers who need follow-up evaluations, particularly if assigned to isolated areas, appointments must be scheduled within a designated timeframe. The DA Form 4036 includes spaces for indicating dates, times, and locations for these necessary evaluations to ensure all medical considerations are addressed before departure.

How long do soldiers have to submit the completed form?

Soldiers must return the completed DA Form 4036 within 21 calendar days from the date indicated on the form. This prompt submission is crucial to ensuring that all necessary evaluations and approvals are completed on time for their overseas assignment.

1. Failing to provide complete information in section 3, NAME (Last, Middle, First). Ensuring that the name is accurate is crucial, as errors can lead to confusion.

2. Leaving section 4, SSN, blank. This information is essential for proper identification and processing of the form.

3. Not checking Item 10 about assignments to isolated areas. This oversight can result in additional requirements being missed.

4. Failing to list all accompanying family members in response to Item 11. Family members need to be screened; omitting names can cause delays.

5. Ignoring the requirement to explain medical conditions in Item 15B. Providing context can affect eligibility for assignment.

6. Missing the deadline for submission in Item 13E. Returning the form within 21 calendar days is important to avoid complications.

7. Not signing or dating the form in sections 13C, 23C, and 27C. Signatures validate the process and confirm the information provided.

The DA 4036 form, which serves as a crucial tool for documenting medical and dental evaluations before service members are assigned overseas, often accompanies several other important forms and documents. Together, they ensure that soldiers and their families meet the necessary health standards for international relocation. Below is a list of other relevant documents commonly utilized alongside the DA 4036.

• DA Form 7652: This form, known as the "Medical Clearance for Overseas Duty," provides detailed medical records and clearances necessary for service members before deployment. It includes information about any ongoing treatments or special medical needs.
• DA Form 4187: Commonly referred to as the "Personnel Action," this form is used to request various personnel changes, including reassignments. It may detail the reasons for the reassignment and any support needed for the service member or their family.
• SGLV 8286: The "Service Member’s Group Life Insurance Election and Certificate" outlines a service member’s insurance coverage. It is essential for soldiers deploying overseas to ensure family financial protection in the event of an unforeseen circumstance.
• DD Form 2790: This document, known as "Application for Department of Defense Dependent School (DoDDS) Enrollment," is used to enroll eligible family members in educational programs abroad. It is crucial for ensuring continuity in education as families relocate.
• DA Form 5123: This is the "Family Member Medical Summary" which provides a comprehensive overview of family members' health statuses. It assists medical facilities in understanding any ongoing medical needs prior to and during the overseas assignment.
• DD Form 1172-2: The "Application for Department of Defense Uniformed Services Identification Card" allows family members to obtain ID cards necessary for accessing military facilities and services while stationed overseas.
• DA Form 5600: Known as the "Department of Defense Civilian Employment Application," this form is often completed by spouses seeking jobs while stationed abroad, facilitating smoother integration into the local workforce.
• SF 86: This is the "Questionnaire for National Security Positions," which is often required for positions that necessitate security clearances. Service members must complete this as part of the clearance process when transferring overseas.
• DA Form 4186: The "Request for Overseas Assignment," this form is used to formally apply for a specific overseas assignment. It may include personal preferences and justifications for the chosen location, along with any applicable circumstances for family travel.

By integrating these various forms and documents, service members and their families can facilitate a smoother transition to overseas assignments. The completion and submission of these documents are paramount for ensuring that both individual service members and their families are adequately prepared for potential challenges associated with relocating internationally.

The DA 4036 form is similar to the DD Form 2766, which is the Adult Preventive and Chronic Care Flowsheet. Both documents serve the purpose of collecting essential health information for military personnel. The DD Form 2766 focuses on chronic conditions and preventive care needs, including immunizations and health screening requirements. Like the DA 4036, it supports medical readiness for deployments and reassignments, ensuring service members meet medical standards before overseas assignments.

Another comparable document is the DA Form 5888, which is the Family Member Deployment Screening Sheet. This form is used to document family members’ medical and dental readiness for relocation. Similar to the DA 4036, it requires family members to undergo screenings to determine if they have any specific medical needs. Failure to comply with these requirements may affect the family's ability to accompany the service member on overseas assignments.

The SF 86, Questionnaire for National Security Positions, also shares similarities with the DA 4036. Both forms collect personal data, although the SF 86 focuses primarily on security clearance requirements. It assesses an individual's background and medical history to evaluate eligibility for national security positions. The thoroughness of both documents helps ensure that personnel are fully prepared for their respective assignments or roles within the military.

Similarly, the DA Form 2500, the Medical Examination - Report of Medical History, is akin to the DA 4036 in its purpose of documenting medical conditions and readiness. Both forms aim to ensure that individuals meet the necessary health standards for deployment. The DA Form 2500 specifically details prior medical issues and current health status, making it essential for evaluation by military medical authorities.

The Medical Evaluation Board (MEB) narrative summary parallels the DA 4036 as well, focusing on an individual’s fitness for duty. This documentation outlines any medical limitations that may impact a service member's ability to perform their duties. Both forms are part of the broader assessment of a service member’s medical readiness before an overseas assignment or deployment.

Lastly, the DA Form 3349, which is used for Physical Profile and Medical Evaluation, demonstrates similar intent concerning physical and medical assessments. This form captures a soldier's physical capabilities and any medical limitations they may have. Like the DA 4036, it serves as a crucial component in ensuring service members are fit for their assigned duties, especially when overseas assignments are involved.

Filling out the DA Form 4036 can be a straightforward process, but it's important to get it right. Here’s a helpful list to guide you through what to do and what to avoid:

• DO provide accurate personal information, including full name, Social Security Number, and rank.
• DO ensure that all medical and dental evaluations are completed prior to submission.
• DO double-check for any special medical instructions related to your assignment.
• DO submit the form along with any required copies within the specified timeframe.

• DON'T leave any required fields blank; incomplete forms may cause delays.
• DON'T misrepresent your medical or dental status; accuracy is crucial.
• DON'T forget to sign the form; an unsigned document may be rejected.
• DON'T fail to consult with your local medical treatment facility if you have questions.

The DA 4036 form is essential for soldiers being reassigned overseas, primarily concerning their medical and dental readiness. However, several misconceptions about this form can lead to confusion. Here are ten common misunderstandings:

• Misconception 1: The DA 4036 form is optional for soldiers being assigned overseas.

This form is mandatory for determining whether soldiers meet medical and dental standards for overseas assignments.

• Misconception 2: Only soldiers need to fill out the DA 4036 form.

Family members accompanying soldiers must also provide medical evaluations, or they risk not being allowed to travel with the soldier.

• Misconception 3: Completing the DA 4036 form guarantees overseas assignment approval.

Submission of the form does not guarantee acceptance; it simply provides necessary information for evaluation of fitness.

• Misconception 4: Soldiers must wait until their assignment is confirmed to complete the form.

It is advisable to begin completion as soon as possible, since timelines for submission are strict.

• Misconception 5: Medical information on the form is not protected and can be shared widely.

The information is covered by privacy laws, and disclosure is voluntary. Soldiers should know their privacy rights.

• Misconception 6: Once filled out, no further action is needed regarding the form.

Soldiers might need follow-up evaluations based on their medical conditions or if they are assigned to isolated areas.

• Misconception 7: The DA 4036 form can be completed by anyone, not just the soldier.

The soldier must provide personal medical and dental information to ensure accuracy and compliance.

• Misconception 8: There are no consequences for submitting the form late.

Timely submission is critical; late submissions can affect the soldier's assignments and their family’s travel permissions.

• Misconception 9: Only medical doctors can fill out the necessary sections of the form.

While medical officers typically complete medical evaluations, the soldier should also ensure they understand and validate the information.

• Misconception 10: All soldiers are required to undergo the same medical assessments.

Assessments may vary based on the soldier's unit assignment, projected duties, and individual health needs.

Here are key takeaways regarding the DA 4036 form, which is used for medical and dental preparation for overseas movement:

• Complete All Sections: Ensure all requested information is filled out accurately, including personal details, current unit, and projected assignment.
• Family Member Screening: If the member is assigned to an isolated area and requests family travel, all accompanying family members must be screened for special medical needs.
• Timely Submission: Submit the original form and one copy to the Military Personnel Division (MPD) within 21 calendar days of the date indicated in the form.
• Required Medical Evaluations: Confirm that the member meets medical fitness standards. If there are limitations, provide explanations as necessary.
• Immunizations: Document any required vaccinations, including HIV screening and hepatitis B vaccination if assigned to specific locations like Korea.
• Remedial Care Necessity: Identify if the member or their family requires any type of remedial medical or dental care and schedule appointments as needed.
• Follow-Up Evaluations: For those assigned to areas with limited medical facilities, coordinate follow-up evaluations within 30 days of the anticipated departure.