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PRINCIPAL PURPOSE: To provide information regarding a Soldier’s status when injury, illness, disease or death occurs. It tracks and ensure Soldiers are receiving proper benefits and proper institutions/agencies are notified regarding payment and benefits.

DA FORM 2173, OCT 72 22. INDIVIDUAL WAS ON 21. ABSENCE WITHOUT AUTHORITY MATERIALLY INTERFERRED WITH THE PERFORMANCE OF MILITARY DUTY (Explain in Item 30 type of duty missed, hours of duty, and how it did or did not interfere with performance) 19 DUTY STATION a. FROM b. TO 20. HOUR AND DATE OF ABSENCE 18. SIGNATURE

da form 2173, oct 1972. replaces da form 2173, 1 jun 66, which is obsolete. apd lc v2.01es. thru: (include zip code) to: (include zip code) from: (include zip code) 1. name of individual examined (last, first, and middle initial) 2. ssn. 3. grade 33. date. 34. typed name and grade of unit commander or unit advisor 4. organization and station ...

Brooke Army Medical Center LOD clerk will initiate a DA Form 2173 for the following soldiers: All cases of death (active duty, national guards and reserve service member), injury or death involving the abuse of alcohol or other drugs and self inflicted injuries.

Form DA 2173, known as the Statement of Medical Examination and Duty Status, is an important document for military personnel. It assesses a Soldier's duty status when they experience an injury or illness.

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2022年9月9日 · A DA Form 2173 is a document used by the Department of the Army when a soldier is injured in the line of duty. These documents must be completed within 7 days of the incident and are valid for 60 or 90 days. Upon completion, the document must be submitted for review and approval by superiors.