Da Form 3349 Fillable - Free Download
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Da Form 3349 Fillable
Da Form 3349 Fillable
NEEDS MEB
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APD PE v1.00ES
This temporary profile is an extension of a temporary profile first issued on
INJURY Or
PHYSICAL PROFILE
For use of this form, see AR 40-501; the proponent agency is the Office of the Surgeon General.
ILLNESS/DISEASE
DA FORM 3349, SEP 2010
PREVIOUS EDITIONS ARE OBSOLETE
7-2 AR 40-501)
3.
Temporary
Permanent
PULHES
4. PROFILE TYPE YES NO
7. DOES THE SOLDIER MEET RETENTION STANDARDS IAW CHAPTER 3 AR 40-501
a. Carry and fire individual assigned weapon
c. Ride in a military vehicle for at least 12 hours per day
e. Wear body armor for at least 12 hours per day
f. Wear load bearing equipment (LBE) for at least 12 hours per day
g. Wear military boots and uniform for at least 12 hours per day
h. Wear protective mask and MOPP 4 for at least 2 continuous hours per day
i. Move 40lbs (for example, duffle bag) while wearing usual protective gear (helmet, weapon, body armor and LBE) at least 100 yards
j. Live in an austere environment without worsening the medical condition
6. APF
T
2 MILE RUN
APFT SIT-UP
S
APFT PUSH UPS
APFT WALK
APFT SWIM
APFT BIKE
FUNCTIONAL ACTIVITY:
YES NO
9. NAME, GRADE & TITLE OF PROFILING OFFICER 10. SIGNATURE
12. NAME & GRADE OF APPROVING AUTHORITY 13. SIGNATURE
17. HOSPITAL OR MEDICAL FACILITY
15. Commanders can access the electronic profiles of Soldiers in their unit(s) by going to http://www.mods.army.mil/ and clicking on eProfile in the list of
applications. Commanders will be required to register and be approved in eProfile before they can gain access to profiles.
18. PROFILING OFFICER E-MAIL
YESN/A NO
a. TEMPORARY PROFILE
(Expiration date YYYYMMDD)
1. MEDICAL CONDITION:
(Description in lay terminology)
2. CODES
(Table
b. PERMANENT PROFILE
(Reviewed and validated with every periodic health assessment or after 5 years from the date of issue)
5. FUNCTIONAL ACTIVITIES THAT EVERY SOLDIER REGARDLESS OF MOS MUST BE ABLE TO PERFORM. IF SOLDIER CANNOT PERFORM ANY ONE OF
THESE TASKS, THEN THE PULHES MUST CONTAIN AT LEAST ONE "3" AND SOLDIER MUST BE REFERRED TO A MEB. CAN THE SOLDIER:
b. Evade direct and indirect fire
d. Wear a helmet for at least 12 hours per day
A
LTERNATE APFT
(Fill out if unable to do APFT run otherwise N/A)
8. FUNCTIONAL LIMITATIONS AND CAPABILITIES AND OTHER COMMENTS
:
11. DATE
(YYYYMMDD)
14. DATE
a. NAME
:
b. GRADE/RANK:
c. SSN:
(YYYYMMDD)
(Last, First)
16. PATIENT'S IDENTIFICATION
(Limited to 3 months duration)
NEEDS MMRB
YES NO
d. UNIT:
YES NO
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