Download the form
The scope here is Department-wide. DD Form 2911 — DD Form 2911, DoD Sexual Assault Medical Forensic Examination Report, September 2015 — exists to DoD Sexual Assault Forensic Examination Report\n \n Download Suspect Instructions \n Download Victim Instructions \n, and it applies across the services rather than inside one. That is what the DD prefix encodes: joint issue, single edition, every branch and defense agency working from identical paper.
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.
Use not stated, status not stated. Older printings circulate widely and lose their currency Department-wide the moment a new edition issues.
Available: PDF, across 15 pages, roughly 200 fields. That is the whole scope of the download decision.
Default to fillable pdf, print only when you must. The fillable file stores what you type; the printable file is a blank picture. A Department form often travels further than a service form — scanned, emailed, forwarded to an agency that never saw the original — and typed text is what survives that.
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.
Verify the edition before the first keystroke. The date on the form face should read not stated. If it does not, discard the file. Field numbering shifts between editions, and on a DD form the new layout reaches every receiving office in every service at once — there is no lag during which the old version is still normal somewhere.
Unclear entries — read the form face, then not stated; the directive prevails.
Submit to the office named in not stated or in local instruction; retain a duplicate before it leaves. Joint routing often sends a DD form across organizational boundaries, and tracing one afterward is not a same-day matter.
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.
Do not read across from a service number. DA numbering is Army-specific under an Army proponent; DD numbering is Department-wide under not stated or an equivalent Department office. The sequences are unrelated, so identical digits in each identify two different documents. Read the prefix, not the digits.
Editions change when the prescribing directive is reissued, when the data collected changes, or when notice language is amended. None of that reaches you. Checking not stated at download is the entire defence, and it is cheaper than repeating a submission.
What is here is the blank form and a description of it. What is not here is legal guidance or any assurance about a particular filing — this page is not the issuing authority and does not speak for one. Those questions go to not stated, to your servicing administrative office, or to the authority identified 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?