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.

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STATEMENT OF MEDICAL EXAMINATION AND DUTY STATUS For use of this form, see AR 600-8-4, the proponent agency is DCS, G-1. INJURY IS CONSIDERED TO HAVE BEEN INCURRED IN LINE OF

Title: Statement of Medical Examination and Duty Status Author: APD Subject: DA Form 2173, Oct 1972 Created Date: 12/23/2013 3:17:44 PM

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.

In coordination with the DoD, CIO, the DD establishes policies and procedures for the DoD Forms Management Program, including responsibilities for reviewing and approving form requirements. DoD forms satisfy a valid need; essential to accomplish a mission and necessary for the efficient and economical operation of the DoD.

2022年9月9日 · What is a DA Form 2173? 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.

DA Form 2173, Statement of Medical Examination and Duty Status is used in cases of either a formal or an informal Line of Duty (LOD) determination process. The latest fillable version of the form can be downloaded below.