Navmed 6100 6-2026

1. Click ‘Get Form’ to open the navmed 6100 6 in the editor.
2. In Section 1, Clinical Information, enter the date, patient SSN, and full name (last, first, MI). Fill in the diagnosis and corresponding ICD-9 CM codes. Provide notes on the return to duty including findings and prognosis. Specify the proposed effective date of return to unrestricted duty and ensure the printed physician's name, signature, and date are included.
3. In Section 2, Patient Information, confirm that you have received full information regarding your return to duty. Sign and date this section to acknowledge understanding that your return is contingent upon approval by the MTF convening authority.
4. In Section 3, Patient Administration/Medical Evaluation Boards Official, ensure all actions are completed. The official will initial and date next to each entry including notifications and briefings. Include their printed name, signature, and date.
5. Finally, review all sections for accuracy before saving or exporting your completed form for submission.

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