Human form 4497-2026

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The document is the U.S. DOD Form dod-da-4497, which is used for conducting an Interim (Abbreviated) Flying Duty Medical Examination. It collects personal and medical information from military personnel to assess their fitness for aviation duty, including details on medications, medical history, and examination results.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the exam date in the format DD/MM/YY at the top of the form.
Fill in your name (Last, First, MI) and Social Security Number (SSN) in the designated fields.
Indicate your birth date using the same DD/MM/YY format.
Select your rank and check one or more components from the options provided.
Specify your aviation duty by checking the appropriate box.
Complete your unit of assignment and provide a complete unit address along with contact numbers.
List any medications and dosages you are currently taking, as well as any aeromedical waivers in effect.
Sign and date where indicated to confirm understanding of medical history requirements.

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