Medical Out-Processing Checklist—PCS

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY: Section 301 Title 5, USC

PRINCIPAL PURPOSE: To ensure the proper in-processing of Soldiers into their gaining installation units.

ROUTINE USES: To in-process Soldiers into their gaining installations and units, to report any non-deployable conditions identified during in-processing to their gaining commanders and to provide historical dates for after action reports and reviews. Forms will not be disclosed outside Department of Defense (DOD) and DOD sponsored agencies.

DISCLOSURE: Disclosure of this information is voluntary; however, failure to disclose the requested information could result in improper in-processing.

Name: (Last, First, MI) / SEX: M / F
SSN: / DOB:
Unit: / Rank:
GO / NO GO / N/A / REMARKS
1 / CONUS or OCONUS PCS / CONUS / OCONUS
1a / ---Soldier has records in possession for OCONUS PCS
1b / ---Soldier has turned in records to MTF for CONUS PCS
2 / Soldier has known allergies identified
2a / --- Soldier has medical warning tags
3 / Soldier is current on adult immunization profile
4 / Soldier has a current HIV test (within 120 days for OCONUS PCS, 2 yr otherwise)
5 / Soldier has a completed DNA card on record
6 / Blood type compared and consistent on both the MEDPROS IMR and ID Tags
7 / For female Soldiers that are pregnant, has OB cleared Soldier for safe travel
8 / Soldier has a current PHA (within 12 mo)
9 / Soldier has Permanent or Temporary Profile? / NONE / PERM / TEMP
9a / ---Soldier’s Profile current in e-Profile
9b / ---Soldier’s Profile current in IMR
9c / ---Permanent 3 or 4, Soldier has undergone or is currently undergoing a MEB or MMRB
9d / ---Having been found retainable, Soldier has received a copy of Record of Retention from MEB/MMRB? (NOTE: Soldier is NOT to PCS without a copy of their Record of Retention)
10 / Soldier has current vision screening
10a / --- Soldier requires corrective lenses
10b / ---Soldier has 2 pair as required
10c / --- Soldier has mask inserts? (corrective lenses only)
11 / Soldiers hearing exam is current
11a / ---Soldier requires a hearing aid
11b / ---Soldier has extra batteries (as required)
12 / Remind Soldiers who have worked around loud noises / radiation / certain heavy metals to schedule appropriate medical examinations (via Audiology and/or PCM)
13 / Any Soldier on long term prescription medication has been encouraged to have a 90 day supply of medication
14 / Soldier has completed history screen for Substance Abuse
15 / Soldier has completed history screen for psychiatric issues