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How to fill out army convalescent leave form

01

Start by obtaining a copy of the army convalescent leave form, also known as DA Form 4179.

02

Begin filling out the form by providing your personal information such as your name, rank, and social security number.

03

Indicate the purpose of the leave by selecting the appropriate box. For convalescent leave, choose the option that best describes your medical condition.

04

Specify the duration of the leave by entering the start and end dates.

05

Provide information about your healthcare provider by including their name, address, and phone number.

06

Obtain the required signatures from your immediate supervisor and the healthcare provider.

07

Review the completed form for accuracy and make any necessary corrections.

08

Submit the form to your unit's administrative office for further processing.

Who needs army convalescent leave form?

01

Any member of the army who requires leave for convalescence purposes is required to fill out the army convalescent leave form. This includes soldiers who are recovering from an injury or illness and need time off to recuperate and regain their physical and mental well-being.

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What is army convalescent leave form?

The army convalescent leave form is a document used by military personnel to request temporary leave due to medical recovery needs following illness, injury, or surgery.

Who is required to file army convalescent leave form?

Service members who are undergoing recovery from medical procedures or conditions and require time off to heal and recuperate are required to file the army convalescent leave form.

How to fill out army convalescent leave form?

To fill out the army convalescent leave form, service members must provide personal details, specify the reason for leave, indicate the dates of requested leave, and obtain necessary endorsements from medical personnel.

What is the purpose of army convalescent leave form?

The purpose of the army convalescent leave form is to formalize the request for leave to allow service members time to recover from medical conditions without the stress of regular duties.

What information must be reported on army convalescent leave form?

The form must include the service member's name, rank, unit, medical diagnosis, treatment dates, requested leave dates, and signatures from both the service member and the attending physician.

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