Download the form
Treat DD Form 2492 as Department-level, which changes how you look for it. Title: DD Form 2492, DoDMERB Report of Medical History, March 2008. Function: DoD Medical Examination Review Board (DoDMERB) Report of Medical History. Because the number carries DD rather than a service prefix, the same edition covers all military departments and the defense agencies at once. Nobody issues a Navy copy or an Air Force copy.
Requirement traces to not stated; the form belongs to not stated. Everything about schedule sits below that in local instruction, which is where to ask if a date matters.
Current edition is not stated, carried as not stated. Check that against any copy you already hold before doing anything else — Department-level revisions land everywhere simultaneously, so a stale file is stale across the whole Department.
The set is PDF. Size: 2 pages, about 103 fields.
Xfdl is a legacy Department format, IBM Lotus Forms, requiring the matching viewer. Its survival in DD distribution reflects how widely it was fielded across the Department, not any advantage over pdf today.
Free download, every format. Do not fill the form in a browser tab — browser pdf viewers handle interactive fields inconsistently and discard entries on close.
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.
Start by matching the printed date to not stated. Old blanks accumulate in shared folders for years. Because the Department reissues to all services in one action, nobody is still accepting the previous layout by local custom.
For anything ambiguous in a specific field, the form's own instructions come first and not stated controls where the two differ.
Send it as not stated or local guidance specifies. Save a copy. Cross-service and cross-agency routing is normal for Department forms, and a lost original outside your own organization is harder to chase down.
Look up cross-referenced forms by series and number. DD numbering is unified across the Department, which removes the usual step of identifying which service issued the thing.
Where a procedure cites both a service form and a DD form, the two are unconnected. Service numbering answers to a service proponent, DD numbering to not stated or another Department office, and the two sequences were never aligned. Matching numbers mean nothing whatever.
Three drivers of revision: directive reissue, altered collection requirements, updated statutory notice text. No notification accompanies any of them, so download fresh and confirm not stated rather than reusing an archived file.
This page publishes a Defense document and explains its contents. It does not advise, does not rule on applicability, and determines nothing about how a completed form will be treated. Direct such questions to not stated, to the servicing personnel office, or to the office designated 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?