AETV - _______ 2d End
TO: Medical Officer
FROM: Commander, ________________________
SUBJECT: Medical Screening For Weight
Reduction/Exercise Program
1. _________________ exceeds
the body fat standard IAW AR 600-9.
2. I request that you conduct
a medical evaluation to determine if the cause of the soldier's overweight
status is due to a medical condition.
_______________________
_______________________
Commanding
DATE:
_________________
AETV - ______ 3d End
FROM: Medical Officer
TO: Commander, ____________________
SUBJECT: Medical Screening For Weight
Reduction/Exercise Program
1. IAW AR 600-9, _______ has
been examined and found to be (FIT)(UNFIT) for participation in a weight
reduction/exercise program.
2. The cause of the
overweight condition (IS)(IS NOT) due to a medical condition.
3. The following action is recommended:
___ Initiation or continuation in a weight
reduction/exercise program.
___ Medical treatment for a pathological medical
disorder.
_______________________
(Signature of Medical
Officer)