Army Forms Archive

DD Form 2499 — DD Form 2499, Health Care Practitioner Action Report, February 2000

Health Care Provider Action Report

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DD Form 2499 — a Department of Defense document. Title of record: DD Form 2499, Health Care Practitioner Action Report, February 2000. Stated purpose: Health Care Provider Action Report. Edition date not stated; status not stated.

Prescribing authority: not stated. Proponent: not stated. Unlike service-specific publications, DD forms carry Department-level authority and apply across the Army, Navy, Air Force, Marine Corps, Space Force and Coast Guard when operating under Defense jurisdiction.

Users include uniformed members of any branch, DoD civilian employees, contractor personnel where authorized, and the administrative staff who process the completed record.

Timing of submission is fixed by not stated and by the implementing guidance of the submitting organization. What follows describes the blank document, not agency procedure.

Formats offered: PDF. Length: 3 pages. Fillable field count: roughly 147.

Pdf serves as the base format. In the fillable variant, each box is an interactive field that holds typed text inside the document. In the flat printable variant, no fields exist — the page prints as a blank to be completed by hand. Typed entries survive transmission; handwriting does not always survive scanning.

Xfdl is present in the set. The format belongs to IBM Lotus Forms — long the Defense standard for electronic forms — and needs the matching viewer; pdf applications will report the file as unreadable.

All formats download free of charge. Pdf files open in any modern reader; interactive fields behave most predictably in a desktop application, less so in browser viewers.

What the form asks for

  • 2. Type of report. Press space bar to mark X in first box if initial, second box if correction or addition, third box if revision to action, or fourth box if void previous report.
  • 1. Date of report (4 digit year, 2 digit month, 2 digit day).1. Date of report (4 digit year, 2 digit month, 2 digit day, no dividers).
  • 1. Date of report (4 digit year, 2 digit month, 2 digit day).3. Date of action (4 digit year, 2 digit month, 2 digit day).
  • 5. Medical treatment facility (MTF). a. Name.
  • b. Address (street, city, state, zip code).
  • c. DMIS code.
  • 6. Practitioner information. a. Name (last, first, middle).
  • b. Social security number. Do not include dashes.
  • 4. Effective date of action (4 digit year, 2 digit month, 2 digit day).3. Date of action (4 digit year, 2 digit month, 2 digit day).
  • d. Name of professional school attended.
  • X first box if in U.S., second box if foreign.
  • c. Date of birth (4 digit year, 2 digit month, 2 digit day).
  • e. Date graduated (4 digit year, 2 digit month, 2 digit day).
  • f. Status. X first box if Army, second box if Navy, third box if Air Force, fourth box if PHS, fifth box if civilian GS, sixth box if partnership internal, seventh box if partnership external, eighth box if personnel services contract, or ninth box if non-personnel services contract.
  • g. Source of accession. (1) Military. X if volunteer.
  • X if Armed Forces Health Professional scholarship program.
  • X if Uniformed Services University of Health Sciences.
  • X if National Guard.
  • X if Reserve.
  • X if other.
  • Specify if other.
  • (2) Civilian. X if Civil Service.
  • X if contracted.
  • X if consultant.

The document is filled from the top down. Identification precedes substance, substance precedes certification. Fields lower on the page are commonly keyed to entries made above them.

Verify the edition date against not stated before entry. Department-level revisions replace the blank across every service simultaneously, so an old copy in a desk drawer may no longer correspond to current field numbering.

Instructions printed on the form or in not stated govern individual field entries. Where the two differ, the governing publication controls.

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.

Related documents are located by series and number. DD forms sit in a single Department-wide sequence, so a form referenced inside DD Form 2499 is normally found by its number alone, without regard to service.

A DD number and a DA number may appear in the same instruction without being related. DA forms belong to the Army alone; DD forms belong to the Department and are administered at Department level. The sequences are independent.

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.

Scope of this page: distribution of a published form and description of its contents. It offers no legal guidance and no assurance regarding any particular submission. Direct procedural questions to not stated, to the servicing personnel office, or to the office designated in not stated.

Questions and answers

What is DD Form 2499?
DD Form 2499, Health Care Practitioner Action Report, February 2000
Which edition is current?
Not stated by the publisher
Who is responsible for this form?
Not stated
In which formats can it be downloaded?
PDF

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