Step 1 of 3 — Confirm what we already know
We pulled this from your health record, your last PHA, and military systems. Read each section and confirm it, or correct anything that’s wrong. Nothing here is a new question.
Step 2 of 3 — Questions only you can answer
These have no answer in your record, or they ask about the last few weeks. Questions that don’t apply to you have been left out.
Step 3 of 3 — Review and submit
This is your complete Part A. Check it over — after you submit, it’s locked and goes to your health care team.
Digital signature
Sign by entering your date of birth or DoD ID number, exactly as they appear in your service record.
That doesn’t match your record. Enter your date of birth (format: dd mmm yyyy) or your 10-digit DoD ID.
Authentication-based signature is wired in the real build; this is a stub.