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The AF IMT 422 form plays a critical role in the management of personnel in the U.S. military, specifically relating to the physical health and readiness of service members. Primarily known as the Physical Profile Serial Report, this form captures essential medical information about an individual, allowing the military to monitor and assess fitness for duty. It includes personal identifiers such as patient ID, grade, and Social Security number, ensuring that records can be accurately matched to service members. In addition to basic information, the form details specific health considerations, including blood types, medical conditions, and whether a service member has any temporary or permanent profiles affecting their assignment. Notably, the form also addresses the necessity for medical evaluation boards (MEB) or physical evaluation boards (PEB), which can be crucial for determining a service member's future in the military. Health care providers and personnel managers must sign the document, verifying the accuracy of the reported information. Ultimately, this concise yet comprehensive form supports the overall mission of maintaining a healthy and mission-ready military force.

422 Example

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PHYSICAL PROFILE SERIAL REPORT

 

 

 

PATIENT ID

(Use plastic card or type/print name)

 

 

 

GRADE

 

DATE

 

 

 

 

 

 

 

 

AFSC

 

SSN

 

 

 

 

 

 

 

 

UNIT

 

 

 

 

 

 

 

 

 

 

BASE

 

 

 

 

PROFILE

P

U

L

H

E

S

SUFFIX

 

BLOOD GROUP DATA

 

PREVIOUS

 

 

 

 

 

 

 

TYPE AND RH

 

REVISED

 

 

 

 

 

 

 

 

DEFICIENCY

 

 

 

 

 

 

 

 

 

G6PD

 

TEMPORARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

REVISED

 

 

 

 

 

 

 

 

SICKLE CELL TRAIT

 

 

 

 

 

 

 

HEMOGLOBIN-S

 

PERMANENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

RELEASE DATE OF TEMPORARY PROFILE OR DUTY RESTRICTION

 

WORLD-WIDE

 

YES

NO

 

 

 

 

 

 

 

 

 

 

INDIVIDUAL DEFECTS/RESTRICTIONS

 

 

 

PASSES COLOR

 

YES

NO

 

 

 

 

 

 

 

 

 

 

MEDICAL DEFECT/CONDITION REQUIRES MEB OR PEB PROCESSING. ASSIGNMENT AVAILABILITY CODE(AAC) 37 APPLIES.

As shown by examination or review of Health Record or current course of treatment, individual is cleared for

 

OVERSEAS ASSIGNMENT

 

RETIREMENT/SEPARATION WITHIN ONE (1) YEAR

 

 

 

 

 

REMOTE/ISOLATED TOUR

 

OTHER (Specify)

 

 

 

 

REMARKS

TYPED OR PRINTED NAME AND GRADE OF HEALTH CARE PROVIDER

SIGNATURE

 

 

 

 

 

 

 

TYPED OR PRINTED NAME AND GRADE OF PES MANAGER

 

SIGNATURE

 

 

 

 

 

 

 

TYPED OR PRINTED NAME AND GRADE OF PROFILE OFFICER

 

SIGNATURE

 

 

 

 

 

 

 

DPMUO

DPMUM

DPMU(R)

DPMPC

DPMAR

 

 

 

 

 

 

 

 

 

AF IMT 422, 19890401, V2

PREVIOUS EDITION WILL BE USED.

COPY 1 - HEALTH

Form Characteristics

Fact Name Detail
What is Form 422? Form 422 is known as the Physical Profile Serial Report. It is used to document an individual's medical profile and restrictions.
Governing Law This form complies with Department of Defense regulations and military directives for health assessments.
Who Uses This Form? Health care providers and military personnel utilize this form to assess an individual's fitness for duty and to assign medical restrictions.
Key Sections Important sections include patient identification, health care provider's signature, and medical defects/conditions that might require further processing.
How to Access the Form The web-optimized version is available for download at www.usa-federal-forms.com. A fillable version can be created at www.fillable.com.

Guidelines on Utilizing 422

Understanding how to fill out the 422 form correctly is essential to ensure that all necessary information is accurately provided. This guide will walk you through the required steps to complete the form effectively, minimizing any potential errors.

  1. Begin by downloading the original full version of the form from the provided link: www.usa-federal-forms.com/download.html.
  2. Gather your personal information, including your name, grade, Social Security Number (SSN), and unit base.
  3. In the Patient ID section, either use a plastic card or carefully type or print your name.
  4. Fill in the Grade, AFSC (Air Force Specialty Code), SSN, Unit, and Base fields.
  5. Next, enter the Profile information, including the appropriate letters for PULHES.
  6. Complete the section for Blood Group Data by specifying the type and Rh factor.
  7. Indicate whether you have a G6PD deficiency or sickle cell trait, and select Yes or No for each.
  8. If applicable, provide the Release Date of any temporary profile or duty restriction.
  9. Choose whether the profile meets the World-Wide assignment criteria by selecting Yes or No.
  10. Detail any Medical Defect/Condition that requires processing through the MEB or PEB.
  11. Fill in the Assignment Availability Code (AAC) as applicable.
  12. Provide any Remarks that may be necessary for your form.
  13. Next, ensure that you include the typed or printed name and grade of the health care provider, then sign the form.
  14. Repeat this with the typed or printed name and grade of the PES Manager, ensuring they also sign.
  15. Finally, complete the section for the Profile Officer in the same manner.

Having filled out the form, ensure that all information is accurate before submitting it. Errors can delay processing. It's a good idea to keep a copy for your records once completed.

What You Should Know About This Form

What is the purpose of the AF IMT 422 form?

The AF IMT 422 form, also known as the Physical Profile Serial Report, is utilized to document an individual's physical profile in the U.S. military. It provides critical information about medical conditions that may affect an individual’s ability to perform specific duties. This form supports the assessment of a service member’s fitness for duty, deployment eligibility, and any necessary medical restrictions.

How do I fill out the AF IMT 422 form accurately?

To complete the AF IMT 422 form, ensure you have the patient’s identification details, including the Patient ID, Grade, and Social Security Number. It is essential to provide accurate medical history, including any individual defects or restrictions. Health care providers must verify the information through examination or a review of the health record. It is crucial that the form is signed by the health care provider and relevant personnel to validate the information contained within it.

Where can I download the full version of the AF IMT 422 form?

The original version of the AF IMT 422 form can be downloaded from the official website: www.usa-federal-forms.com/download.html. This download will provide you with the complete and detailed version needed for formal documentation.

Can I convert the AF IMT 422 form into a fillable format?

Yes, you can convert the AF IMT 422 form into a fillable format using services available at www.fillable.com. This allows you to fill out the form digitally, which can facilitate easier submission and record-keeping. Additionally, the website offers demos and examples to assist you in this process.

Common mistakes

Filling out the 422 form can be straightforward, but many individuals make common errors that can lead to processing delays or other issues. One prevalent mistake is failing to provide accurate personal information. Ensure that the name, patient ID, and other identifying details match official records. This prevents confusion and misidentification.

Another frequent error is overlooking the requirement for the healthcare provider's signature. The form must include the validation of a qualified professional. Without this signature, the form may be considered incomplete, jeopardizing the request for medical profiles.

People often neglect to check for accuracy in the dates provided. Incorrect dates, particularly the release date or duty restriction, can have significant implications, impacting assignment eligibility or placement.

When it comes to medical information, failing to specify conditions can lead to incomplete profiles. It is essential to clearly indicate any medical defects or restrictions. Providing a detailed account helps in the proper assessment of an individual’s fitness for duty.

Another mistake is not understanding the categories. The form requires individuals to choose between various options, such as 'Worldwide Assignment' or 'Remote/Isolated Tour.' Misselecting these categories can create complications later in the processing stages.

Many tend to overlook listing past medical conditions. Neglecting to include previous types and Rh data, or failing to mention conditions requiring Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB) processing, could lead to serious issues down the road.

Legibility is crucial. If the form is hard to read, it can result in misunderstandings and errors. Handwritten responses should be neat and clear, or typed information should be free of errors.

Also, individuals sometimes forget to review the entire form before submission. Skimming through the document could cause them to miss critical information or signatures needed for the form's completion.

Inserting the wrong Unit or Base can create discrepancies in the individual’s military records. It is vital to verify this information to prevent complications in service assignments.

Lastly, individuals often fail to keep a copy of the filled-out form. Retaining a copy is essential for personal records and can assist in future reference or inquiries regarding the submitted profile.

Documents used along the form

The AF IMT 422 form is often accompanied by several other forms and documents that help to provide a comprehensive overview of an individual's health status and assignment eligibility. These documents ensure accurate record-keeping and facilitate appropriate medical evaluations. Below is a list of commonly used forms related to the AF IMT 422.

  • AF Form 1042: This form evaluates an individual's physical condition and suitability for flying duties. It details health risks and any limitations that may affect flight safety.
  • AF Form 560: This is the “Application for Transfer to Retired List.” It is used by service members to formally request a transfer to retired status, ensuring necessary medical reviews are completed beforehand.
  • AF Form 3979: This document is the “Medical Evaluation Board (MEB) Request.” It invokes the MEB process for individuals whose medical conditions may affect their career in the military.
  • DD Form 2808: This is the “Report of Medical Examination.” It records the findings from a physical exam and is crucial for establishing overall health and readiness for duty.
  • DD Form 214: This form, known as the “Certificate of Release or Discharge from Active Duty,” summarizes an individual's service record and medical status upon discharge or retirement.

Using these forms in conjunction with the AF IMT 422 is critical for ensuring all relevant health information is documented and assessed. Proper completion and submission of these documents can significantly impact medical processing and readiness for assignment.

Similar forms

The AF IMT 422 form is similar to several other forms in regard to structure, purpose, and the type of information collected. Here are nine documents that share similarities with the AF IMT 422:

  • DD Form 2992: This document is used to evaluate the fitness of a service member for duty. Like the 422 form, it requires medical information and assessments regarding the individual's health status.
  • DA Form 3349: The purpose of this form is to record physical profile information. It includes data about an individual's medical conditions similar to the AF IMT 422.
  • AF Form 469: This form is utilized to manage duty limitations due to physical or medical issues. It closely mirrors the restrictions outlined in the 422 form.
  • SF 600: This is a chronologic record of medical care. It documents health history and conditions, resembling the patient ID and profiles mentioned in the 422 form.
  • AF IMT 216: The AF IMT 216 is used for documenting evaluations of personnel for overseas duty. Similar to the 422, it considers medical clearance for assignments.
  • DD Form 2808: This form serves as a report of medical examination. It provides detailed health status information, just like the examination information in the AF IMT 422.
  • DD Form 214: While primarily a discharge document, it includes information about medical evaluation at separation, akin to the determinations made in the AF IMT 422.
  • AF IMT 3880: This is a request for a medical fitness determination. It similarly assesses health and fitness for specific duties, much like the AF IMT 422.
  • DA Form 705: This is the Army Physical Fitness Test Scorecard. While it focuses on physical fitness, it also relates to the physical evaluations performed on the AF IMT 422.

Dos and Don'ts

When filling out the 422 form, it's important to follow certain guidelines to ensure accuracy and compliance. Here are some recommendations:

  • DO: Use clear and legible handwriting or type the information to avoid misinterpretation.
  • DO: Double-check all personal information such as name, ID number, and date to ensure everything is correct.
  • DON'T: Leave any required fields blank; make sure to complete all sections as needed.
  • DON'T: Use any liquid paper or correction fluid on the form; it can create confusion and may lead to rejection of the document.

By following these tips, you can navigate the process of completing the 422 form more effectively. This helps in avoiding common pitfalls that may delay processing.

Misconceptions

Understanding the AF IMT 422 Form is crucial for service members and their health care providers. However, several misconceptions often arise regarding its purpose and use. Below is a list of ten common misconceptions, along with explanations to clarify them.

  1. The AF IMT 422 Form is not mandatory. Some believe that completing the form is optional. In fact, it is required for specific medical evaluations and clearances.
  2. Only officers need to complete this form. This is incorrect. All service members, regardless of rank, may need to submit the AF IMT 422 as part of their medical assessment.
  3. The information on the form is not confidential. Many misunderstand that the data is shared widely. In reality, the information is treated with a high level of confidentiality and is protected under privacy laws.
  4. The AF IMT 422 only applies to physical conditions. Some think the form is limited to physical health issues. However, it also encompasses emotional and psychological assessments related to deployment eligibility.
  5. Filling out the form guarantees overseas assignment. There is a misconception that submission ensures a member will be cleared for overseas duty. Clearance is dependent on medical evaluations and circumstances, not solely on completing the form.
  6. The form can only be filled out by medical professionals. While health care providers typically complete it, service members can also provide information relevant to their health status.
  7. Submitting the form ends all medical evaluations. Some individuals assume that once the form is submitted, no further evaluations are needed. This is untrue; ongoing assessments might still be required based on the individual's condition.
  8. The AF IMT 422 is a one-time requirement. Many believe they only need to fill it out once in their career. However, updates might be necessary due to changes in health status or duty assignments.
  9. The form only concerns medical history. While it includes medical history, it also covers current health assessments and restrictions that impact duty assignments.
  10. After submission, the form is no longer relevant. Some feel that once the form is submitted, it becomes obsolete. On the contrary, it remains relevant as long as the individual’s health condition or assignment eligibility is in question.

These misconceptions can lead to misunderstandings about the form's importance and usage. Clarity on these points ensures that service members and healthcare providers can navigate the requirements effectively.

Key takeaways

When filling out the 422 form, several key points can help ensure a smooth process. This form is essential for documenting physical profiles and medical conditions for military personnel.

  • Use the Correct Version: Make sure you are filling out the latest version of the form. The original full version can be downloaded from designated websites.
  • Clear Identification: Fill in the patient ID accurately, using either a plastic card or by typing/printing the name clearly. This helps to avoid any confusion later.
  • Complete Medical Data: Provide thorough information regarding medical defects or conditions. This includes specifying whether a condition requires Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB) processing.
  • Signatures Matter: Ensure that the health care provider, PES manager, and profile officer all sign the form. This is vital for validation and processing.
  • Highlight Any Restrictions: Clearly indicate any individual defects or restrictions, such as those affecting overseas assignment eligibility. This information is crucial for assignment planning.
  • Review before Submission: Before submitting the completed form, review all entries for accuracy and completeness. Errors can lead to delays in processing.

Being diligent when filling out the 422 form can significantly simplify the management of medical profiles and assist in understanding personnel readiness. Each step in this process plays a vital role in compliance and clarity.