‘ SECTION D - MEDICAL BOARD PROCEEDINGS

ACTION BY MEDICAL BOARD
PERMANENT CHANGE OF PROFILE AS RECORDED UNDER SECTION C, 1S RECOMMENDED __

18 TS PED NAME, GRADE & BRANGH OFBOARD MEMBER (fresideni)| SIGNATURE

16.

we OC

1+ PED NAME, GRADE & BRANCH OF BOARD MEMBER.

“STVPED NAME, GRADE & BRANCH OFBOARDMEMBER |SIGNATURE

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ACTION BY APPROVING AUTHORITY
THE FINDINGS AND RECOMMENDATIONS OF THE BOARD ARE APPKOVED:
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TYPED

N4&ME. GRADE &

TITLE OF APPROVING

|SIGNATURE

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CATE

AUTHORITY

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SECTION E - ACTION BY UNIT COMMANDER/ PERSONNEL OFFICER
The permanent change in profile has been compared with the physical standards as outlined in AR 611-101

or AR 611-201 for individuals PMOS and reclassification action under AR 600-200 or AR 611-1U3 is

(considered but not required)

(initiated)

9. TYPED NAME. GRADE & TITLE

-

REMARKS

-

CONTINUATION

OF

SIGNATURE

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ITEM

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Assignment Restrictions, or Geographical, or Climatic Area Limitations
CODE:

A- None
B- None
C - No crawling, stooping, running. jumping, marching or standing for lung periuds. (State time permitted
in item 8)
D - Nu strenuous physical activity. (State time permitted in item 8)
E - No assignment tu units requiring continued consumption of combat rations.
F - No assignment to isolated arcas where definitive medical care is nut available. (MAAG - Military
Alissions, ete.)

G - Nu assignment requiring handling uf heavy materials including weapons. No overhead work, nu pull-ups
ur push-ups. (State time permitted in item 8)
H - No assigninent to unit where sudden loss of conscigusness would be dangerous to self or others such

as work on scaffolding, handling ammunition, vehicle driving, work near moving machinery,

J - No assignment involving ex pusure to luud noises or firing of weapuns.

(Not to include firing for POR Qualification)

L - No assignment requiring daily exposure to extreme cold. (List specific time or areas in Item 8)

M“P UL -

No assignment requiring exposure tu high envirunmental tenipe: dlure. (List specific time ur areas in item 8)
No continuous wearing of combat boots. (State the length of time in item 8)
No continuous wearing of woolen clothes. (State the length of time in item 8)
Limitation not otherwise described to be considered individually. Briefly define limitation in item 8.

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