Who needs a FCC507 form?
This form is used in the U.S. Army as a part of Profile Request Packet. This form is completed by the soldier and the physician who made the examination.
What is the purpose of the FCC507 form?
The Functional Capacity Certificate Form may be required by a commander to view the soldier’s medical profile. The documents provides the basic information of the soldier’s health condition, chronic diseases as well as physician statement.
The information is used for providing the suitable conditions for the soldier’s training according to their needs.
What other documents must accompany the FCC507 form?
The certificate is a part of Medical Profile Request Packet and it accompanied by the Medical Profile Request form, personal physician letter (if applicable), X-ray reports, information about the pregnancy (date of pregnancy test and expected due date).
When is the Functional Capacity Certificate due?
The soldier has to complete the certificate as soon as they receive the request. The estimated time for completing the form is ten minutes.
What information must be provided in the FCC507 form?
- This form is a questionnaire, and the soldier has to answer all 25 questions concerning their health, chronic diseases, medical background, stamina and physical abilities. The answers should be Yes or No.
- The bottom part of the certificate is filled out by the examining physician. The physician is to complete the following sections:
- Physician’s findings (limitations)
- Physician’s statement
- Description of limitations (permanent, temporary)
- Information about the physician (name, date of evaluation, signature, medical degree, medical specialty, phone number).
What do I do with the FCC507 form after its completion?
The completed certificate and other documents supporting the Medical Profile Request Packet are sent to the unit which requested it. It’s highly recommended that the soldier keeps the copy of the certificate for personal records.