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Defense Department form, series DD, number 2492. Full title: DD Form 2492, DoDMERB Report of Medical History, March 2008. Function: DoD Medical Examination Review Board (DoDMERB) Report of Medical History. Edition in force: not stated. Publisher status: not stated.
Governing directive: not stated. Responsible office: not stated. The DD designation signals joint scope — all military departments, combatant commands and defense agencies draw on a single edition of the document.
Common users: service members regardless of branch, Defense civilian staff, and the offices that file, verify or retain the finished document.
When the form is filed is a matter of not stated and local instruction. The description here covers the document itself and how to obtain a copy.
Available formats: PDF. The form runs 2 pages and contains approximately 103 fillable fields.
Free download applies to every format listed. Any current pdf reader opens the pdf files, though field behaviour is most reliable in a full desktop reader rather than a browser preview.
What the form asks for
- 1. Name (last, first, middle initial).
- 2. Social security number. Do not include dashes.
- 3. Telephone number (include area code).
- 4. Purpose of examination.
- 5. Examination facility or examiner and address (include zip code).
- 6. Date of examination (4 digit year, 2 digit month, 2 digit day, no dividers).
- 7. Have you ever or do you now use any of the following: Amphetamines. Press space bar to mark X in first box if yes, second box if no.
- Barbiturates. X first box if yes, second box if no.
- Cocaine. X first box if yes, second box if no.
- Narcotic drugs. X first box if yes, second box if no.
- Marijuana. X first box if yes, second box if no.
- Alcohol. X first box if yes, second box if no.
- Chemical inhalants. X first box if yes, second box if no.
- Hallucinogens. X first box if yes, second box if no.
- 8. Do you wear glasses? X first box if yes, second box if no.
- 9. Do you wear contact lenses or corneal eye retainers? X first box if yes, second box if no.
- 10. Have you ever had your vision improved by methods other than stated in questions 8 or 9? X first box if yes, second box if no.
- 9.a. If you wear contact lenses, how many days have they been removed prior to this examination? X first box if less than 3, second box if 3 - 30, third box if 21 or over.
- Type lens: X first box if hard, second box if soft.
- Have you ever had or do you now have: 11. Eye trouble (exclude glasses, contact lenses). X first box if yes, second box if no.
- 12. Have fluctuating vision or double vision. X first box if yes, second box if no.
- 13. Have any allergies. X first box if yes, second box if no.
- 14. Take any medications regularly. X first box if yes, second box if no.
- 15. Stutter or stammer. X first box if yes, second box if no.
Completion runs in the order printed on the page: identifying data at the head, the body of the entry next, certification at the foot. Header data frequently governs what belongs in the fields below it.
Edition in use: not stated. Because DD forms are revised at Department level and distributed to all services at once, an obsolete printing may not match the fields an office expects. The date is printed on the form face.
The signature block takes an actual signature. On paper this means ink; electronically it means a credentialed digital signature, commonly CAC-based. Typed text in a signature field satisfies neither.
Where personal information is collected, a Privacy Act Statement appears on or with the form. It names the collection authority, the purpose, the routine uses of the data and the consequence of withholding it. Reading it precedes filling the form.
Errors seen most often involve edition mismatch, empty mandatory fields, illegibility after scanning, date formats inconsistent with the printed instruction, and unsigned or undated certification.
Guidance for specific entries sits on the form face and in not stated; the directive is authoritative where the two do not agree.
After completion, the copy goes to the office designated by not stated or by local procedure. Retention of a personal copy is ordinary practice and costs nothing.
Cross-referenced forms are found through the numbering system. The DD sequence is Department-level and unified, which means a number cited on the page identifies one document across the whole Department.
Some procedures pair a DD form with a service form. The two numbering systems are separate — service forms answer to a service proponent, DD forms to not stated or another Department office — and a matching number in each system means nothing.
Editions change because the underlying directive changes, because collection requirements are revised, or because Privacy Act language is updated. Checking the edition date at the point of download is the practical response.
The material here is descriptive. Nothing on the page constitutes legal or procedural advice, and no statement here determines whether a submitted form will be accepted. Such questions go to not stated, a servicing administrative office, or the authority identified in not stated.
Questions and answers
- What is DD Form 2492?
- DD Form 2492, DoDMERB Report of Medical History, March 2008
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?