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DD Form 2911 — a Department of Defense document. Title of record: DD Form 2911, DoD Sexual Assault Medical Forensic Examination Report, September 2015. Stated purpose: DoD Sexual Assault Forensic Examination Report\n \n Download Suspect Instructions \n Download Victim Instructions \n. Edition date not stated; status not stated.
Issued under not stated, with not stated as proponent. A DD number marks a Department-wide instrument: the same blank form serves every military department and the defense agencies, rather than one service alone.
The form reaches military personnel across the services, civilian employees of the Department, and the personnel and records specialists who receive it.
Submission follows the schedule set by not stated and by local implementing procedures. This page provides the blank form for download and general orientation only.
Available formats: PDF. The form runs 15 pages and contains approximately 200 fillable fields.
The pdf is the primary distribution format. A fillable pdf accepts typed entries in defined field boxes and stores them in the file; a printable pdf is a flat image of the blank, meant for pen entry after printing. The distinction matters for legibility and for records that pass between offices.
The xfdl release corresponds to IBM Lotus Forms. This format carried Department-wide form distribution for years and opens only in IBM Lotus Forms Viewer or a compatible client, not in a pdf reader.
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
- A. General Information. Name of medical facility:
- 1a. Name of patient (last, first, middle initial).
- 1b. Patient ID number.
- 2a. Address (street and apartment number).
- 2b. City.
- 2c. County.
- 2d. State.
- 2e. Zip code.
- f. Telephone (include area code). (1) Home.
- (2) Work telephone number.
- 3.a. Age.
- b. Date of birth: 4 digit year, 2 digit month, 2 digit day, no separators.
- c. Gender. Press space bar to mark X in first box if male, second box if female.
- d. Ethnicity. X first box if Hispanic or Latino, second box if not.
- e. Race (X all that apply). Mark X if American Indian/Alaska native.
- Mark X if Asian.
- Mark X if black or African American.
- Mark X if white.
- 4.a. Arrival date (4 digit year, digit month, 2 digit day).
- b. Arrival time.
- 5.a. Discharge date (4 digit year, digit month, 2 digit day).
- b. Discharge time.
- B. Notification and authorization. Location of assault. X first box if on installation, second if off installation.
- Jurisdiction: X first box if city, second box if county, third box if other.
Order of completion: identification block first, substantive entries second, certification and signature last. The blank is laid out in that sequence and the sequence is not arbitrary — later entries often depend on data established in the header.
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.
Instructions printed on the form or in not stated govern individual field entries. Where the two differ, the governing publication controls.
The completed document moves to the office named in not stated or in local guidance. A retained copy is conventional practice.
Related documents are located by series and number. DD forms sit in a single Department-wide sequence, so a form referenced inside DD Form 2911 is normally found by its number alone, without regard to service.
Where a DA form is cited alongside a DD form, the two belong to different systems: DA numbering is Army-specific and administered by an Army proponent, while DD numbering is Defense-wide under not stated or an equivalent Department office. Numbers do not translate between the systems.
Revision occurs when the prescribing directive is reissued, when the data collected changes, or when statutory notice language is amended. Verification of the edition date at download addresses all three.
This page distributes a published Department of Defense document and describes it. It is not a source of legal advice and makes no representation about acceptance of any completed form. Questions of applicability, eligibility or procedure belong to not stated, the servicing personnel office, or the office named in not stated.
Questions and answers
- What is DD Form 2911?
- DD Form 2911, DoD Sexual Assault Medical Forensic Examination Report, September 2015
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?