Afi 48 133
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Uses of the AF Form 422 are based on what guidances?
AFI 48-123, and AFPAM 48-133
The AF Form 422, communicates information in what terms to who?
Laymans terms, to non-medical personnel on the general physical condition/specific duty limitations of military members.
The AF Form 422 advises who on a members World Wide Duty Qualification status?
MPF, and AFPC
The AF Form 422, ensures individuals meet what?
prerequisite medical requirements of an AFSC
A 1 on a profile is?
Acceptable Standards, free of any significant organic defects or systemic diseases.
A 2 on a profile is?
Acceptable Standards, presence of minimally significat organic defects/systemic diseases.
A 3 on a profile is?
Acceptable Standards, significant defect/disease under good control and not requirng regular supervions/medical support.
A 4 on a profile is?
Unacceptable standard, severe organic defects, systemic or infectious diseases. Indicates member not medically qualified for Wordwide duty. The AFI/AFPAM, gives specific considerations/descriptions for marking standards as well as specifi
AF 48-123, and AFPAM 48-133, gives specific consdierations and descriptions for?
Marking standards as well as specific guidance to complete the form.
Who identifies/initiates notifcation on a MEB, and what form is used?
Medical Corps (MC) officer, AF 570.
Ther AF 570 is forwarded to who?
the Physical Evaluation Board Liasion Officer (PEBLO)
The PEBLO must notify Force Health Management Office or PCM of AD/ARC medical facility for ARC members of what?
The need to complete a 4T profile on the members.
The "P" in PUHLES is?
Physical - condition relative to organic defect, systemic disease that are not normally rated under other profile factors.
The U in PUHLES is?
Upper Extremities (bones, joints muscles) ie. Hands/Arms, Shoulder girdle, Cervical/Thoracic spine. Rate functional use, strength, ROM and general efficiency.
The L in PUHLES is?
Lower Extremeties- Feet and lefs, pelvic girdle, lumbar and sacral spine. Rate functional use, strength, ROM and general efficiency
The E in PUHLES is?
Eye- Only Distant visual acuity is considered, Vision standards include both corrected/uncorrected vision.
The H in PUHLES is?
Hearing, Only auditory acuit is considered, exceeding the hearing profile definition/standard for H-1, H-2, automatically places the individual in the next higher category.
The S in PUHLES is?
Psychiatric Emotional stability/neuro-psychiatric hx and findings are considered.
Psychiatric Profiles are a formal means to?
Notify commanders, medical personnel of the impact of a condition on ability to perform military service.
Psychiatric Profile changes from S1 should be considered if?
There is impairment or potential impairment due to illness, or medication use which necessitates command considerawtion of changing or limiting duties.
Psychiatric Profile when impairment or potential impairment is so minor as to have no impact on military service, it is?
Not necessary to change the S Profile.
Psychiatric profiles are based on an operational risk management model. Profile decisions should be coupled to?
Both mishap probability (chance that medication/illness related duty impairment will occur) and the hazard severity(the danger to mission, security, or safety should the impairment impact the person's function at a critical time)
W Suffix is?
Indicates member is qualified for retention, any combinations of 1,2,3
T Suffix is?
Contains 1 or more 4's, indicates member is temporarily not qualified for retention or is undergoing an MEB to determine fitness.
The T suffix, the defect is tempory and can not be imposed for more than?
12 months without MEB/PEB
The T suffix, medical conditions requirng a profile are?
cumulative in anture, even when profile preiods are intermittent, the sum of all profile time periods for the condition are totaled to determine the standard.
The T suffix, should ot be use with
1,2,or 3 profile.
A member is awarded what code following a MEB/PEB?
Assignment Limitation Code (ALC-C)
The AF Form 422 must contain one or more 4's a "T" suffix, and a statement assigning the ALC-C in the?
Remarks section.
The Assignment Limitation code is authorized by?
AF Manpower Center, member is precluded from deployment and unrestricted assignment until ALC-C is removed.
The L Suffis is utilized when?
Personnel are on limited assignment status, the suffix is rare an may be used or assifned to AF personnel only by HQ/AFPC/DPA, ALC-C and DAC 42 codes.
Member has been awarded ALC-C or DAC 42 if member is?
A member of the Air Reserve Component.
The intent of the ALC-C and DAC-42 is to protect members from?
Being placed in an environment where they may not receive adequate medical care for a possible life-threatening medical condition and to prevent assignment of non-qualified personnel to overseas locations.
Assignment Limitation Code C restricts assignment and deployability to?
CONUS, Alaska (Elmendorf), and Hawaii and will prevent reassignment elsewhere without prior approval by designated approval authorities.
A profile with an ALC-C still remains a 4-T. It contains one or more 4's with a T stuffix and statement in remarks, if it is awarded it will fall into?
A tier, Tier 1 (ALC-C1), Tier 2 (ALC-C2), Tier 3 (ALC-C3)
ALC-C and DAC-42's are only authorized by?
HQ/DPAMM and are subsequently entered into the personnel data system.
Completing the AF Form 422, what is entered for pt ID?
Name, Grade, SSN, Date of Exam, AFSC, Unit, Base
Serial Sets, Previous profile copy from?
Previous AF Form 422, Physical serial report, caution Ensure previous profile serial sets were transcribed correctly. In no previous 422, use the SF 88 or DD Form 2208, Report of Medical Examination.
Serial Sets, Revised Temporary--Do not revise for?
Only minor temporary injuries/ilness.
Use Revised Temporary block if the defect will?
Render the member not qualified for Worldwide service, or is expected to resolve within 60 days.
The Revise Temporary block Should Not be complted unless it contains?
At least one 4, enter under one or more factors to indicate the member is not qualified for worldwide service. If unused dash the item.
What is Revised Temporary example for use?
Fx arm treated w/cast for 5 wks. Member may be placed on short duration 4-T if provider does not want member deployable. MEB is not anticipated (assignment code 31) Under U place 4 and assign a T suffix.
What is Revised Temporary Exxample not used for?
Lower back pain tx with meds and specific duty limitations recommeded, Dash all blocks in revised tempory and revised permanent serial sets.
Temporary Occupational restrictions use?
an AF Form 422, AF Form 1042, and DD Form 689 (sick slip)
Temporary Occupational restrictions use, is to inform member's unit commander or supervisor that member has an injury/illness which limiits?
Job performance or deployability for a specific time period.
When completing the Suffix applace appropriate suffix for each area, place a?
W or T, An L is rare and can only be authorized by AFPC/DPAMM.
When placing the Release date you are considering?
The date the illness/injury will be resolved, must coincide w/the SOAP note.
What else is required on AF Form 422?
Blood group data, WWQ--yes/no, Coincide w/SOAP note.
Under individual restrictions/defecets you annotate?
Pts restrictions, retrieved from Health Care Provider's tx plan, DO NOT enter defects due to HIPAA.
If medical defect requires an MEB you?
Place assignment avilability Code (AAC) 37, check this block if the defect condition requires MEB action or restrictions will last longer than 12mo
What are Type's of clearances on the AF Form 422?
Overseas Assignment, Retirement/Seperation, Remote or Isolated Tour, Other--PHA
The remarks section is used for?
Additional data that clarifies the action recommended or this space can be used to continue any other blocks as neede. Use this section to document the assignment or removal of an ALC-C or DAC-42
Health care provider sign AF Form 422, when used to?
Inform commande/supervisor that the member has an injury or illnes that limits job performance.
Force Health management?
Reviews, signs, and distributes form. Every profile must be signed by FHM (designated representative) and at least one health care provider.
Designated profile offficer signature only required for?
AF 422's processed to change temporary or permannet profile serial report or for those which were initiated by record review or requested by the MPF. Signature NOT required for Temporary occupation restrictions less than 60 days.
When are revisions/reviews accomplished?
During a standard or special physical exam or PHA. Member selected for remote, isolated, or combat zone assignment.
If member possesses a 4T profile, evaluate status every how many days, and utilize what assignment availability codes?
30 days, Codes (AAC) 31-81 roster generated by the MPF
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