DD Form 689, Individual Sick Slip: Blocks, Sections, and Disposition

To fill out and submit a DD Form 689 Individual Sick Slip, the service member enters patient identification in Blocks 1 through 6, the unit commander or designee completes Blocks 7 through 9 with duty status and remarks before sick call, the medical officer records the line-of-duty finding, disposition, and any restrictions in Blocks 10 through 13, and the service member hand-carries the signed form back to the unit. The current edition is dated August 2017 and moves between three people during a single sick-call encounter.

Where to Get a Blank Form

The authoritative blank is hosted by the Department of Defense Executive Services Directorate and can be downloaded and printed as a fillable PDF.¹ Most troop medical clinics, aid stations, and battalion aid stations keep pre-printed copies at sick call, so you rarely need to bring your own. If your unit does require you to arrive with a blank, use the ESD download rather than an older edition.

Who Fills Out Which Section

The form does not stay in one person’s hands, and the order matters. AR 40-66 requires it to be initiated in two copies, one for the medical facility’s health record and one for the unit.²

The service member (or someone at the unit or clinic) fills in patient identification in Blocks 1 through 6.
The unit commander or designee completes Blocks 7 through 9 before the member goes to the clinic.
The medical officer completes Blocks 10 through 13 during or after the visit.
The service member takes the completed form and delivers it back to unit command.

Patient Identification: Blocks 1 Through 6

The top of the form captures who the patient is and why they are being seen. These fields can be completed by the member or by someone acting on their behalf.²

Block 1, Medical Condition. Check either Illness or Injury and write a brief description. Short is fine. “Sore throat” or “right ankle sprain” does the job.
Block 2, Date. Enter the date in YYYYMMDD format. April 15, 2026 is written 20260415.
Block 3, Patient’s Name. Last name, first name, middle initial.
Block 4, DoD ID Number. The August 2017 edition uses the DoD ID number and no longer has an SSN field.¹
Block 5, Grade/Rank. Current pay grade or rank abbreviation, such as E-4 or SGT.
Block 6, Organization and Station. The unit designation and duty station, for example “B Co, 2-87 IN, Fort Drum.”

Get Block 6 right. Medical facilities use the unit information to route the form and any follow-up back to the correct command, and a vague entry can delay notification to your leadership.

Unit Commander’s Section: Blocks 7 Through 9

Before the member reports to the clinic, the commander or a designated representative completes the bottom-left portion.

Block 7, In Line of Duty. AR 40-66 instructs that this block be left blank at the command level. The formal line-of-duty determination is handled separately under AR 600-8-1, not on this form.²
Block 8, Remarks. AR 40-66 lists four kinds of information for this block: the member’s duty status at the time of the condition (duty, leave, AWOL, and so on); for non-battle injuries, how, when, and where the injury happened; any specific requests to the medical facility; and any other information that might help the provider.²
Block 9, Signature of Unit Commander. The commander or designee signs here.

A specific request in Block 8, such as “Request psychiatric evaluation” or “Can this individual perform kitchen duty?”, gives the medical officer direct guidance on what the command needs to know. Leaving it blank is allowed but wastes an opportunity.

Medical Officer’s Section: Blocks 10 Through 13

The provider fills out the right side of the form during or after the clinical encounter.

Block 10, In Line of Duty. The medical officer marks Yes (EPTS) or No (EPTS). EPTS stands for “existed prior to service.”¹
Block 11, Disposition of Patient. One of six options: Duty, Quarters, Sick Bay, Hospital, Not Examined, or Other, with space to specify.
Block 12, Remarks. The provider writes specific duty limitations, environmental restrictions, and follow-up instructions here. There are no pre-printed checkboxes for common restrictions, so anything the command needs to know has to be spelled out.¹
Block 13, Signature of Medical Officer. The provider’s signature validates the entire medical section. The form has no separate printed-name field.

Any type of military medical professional can sign Block 13, including providers from dental and behavioral health clinics. The form is a general-purpose communication tool, not limited to primary care.

What Each Disposition Means

Block 11 is the heart of the form. It tells the commander what the member can and cannot do.

Duty. The member returns to full duty. If the provider writes limitations in Block 12, such as “no lifting over 25 lbs for 5 days,” the member is returned to duty with temporary restrictions rather than placed on quarters.
Quarters. The member is sent home or to the barracks for medically directed self-treatment and does not perform military duty until a medical officer clears them. In the Air Force, quarters on a DD Form 689 can last up to 72 hours; anything longer requires a determination from the member’s primary care manager, and other services follow similar timeframes. A member on quarters is generally expected to remain at their residence or barracks except for meals and medical appointments.³⁴
Sick Bay. Used primarily in Navy and Marine Corps settings for observation or treatment short of formal hospitalization.
Hospital. The member is being admitted to a military treatment facility or referred for inpatient care.
Not Examined. The member reported to sick call but was not seen, whether because the clinic was at capacity or because they arrived outside sick-call hours. The form still documents the attempt.
Other. A catch-all with space to specify, used for referrals to an outside civilian provider or transfers to another facility.

Block 12 does the heavy lifting for anything beyond the basic disposition. A Quarters designation tells the commander the member stays home; the remarks tell the commander everything else, such as no running for seven days, no food handling, must wear a sling, follow up on Thursday. A blank Block 12 on a Quarters slip leaves the command knowing the duration but not the restrictions when the member returns.

Turning the Form In

After Block 13 is signed, the service member takes custody of the completed slip. AR 40-66 directs providers to give the form to the service member for delivery to unit command.² In most units that means handing it to your first-line supervisor or the orderly room. Do not sit on the form. If you miss duty based on a Quarters designation and never turned in the slip, your chain of command has no documentation that you were authorized to be absent.

Once the command receives the form, an important rule applies. Guidance from the 21st Theater Sustainment Command states that unit commanders will not override duty limitations or instructions on a physical profile, and if a commander believes a member’s performance is inconsistent with the documented restrictions, the proper course is to contact the profiling officer directly.³ Sick-slip restrictions carry less formal weight than a physical profile, but they still represent a medical officer’s clinical judgment.

The clinical encounter documented on a sick slip should also be recorded in the service member’s permanent health record.² The paper slip is a temporary communication tool; the electronic record of the visit is what carries legal weight later in a disability claim, a line-of-duty investigation, or a medical board.

When a DD Form 689 Is Not the Right Form

The DD Form 689 handles short-term, temporary limitations. Longer-term or permanent duty restrictions belong on a physical profile, DA Form 3349, which uses the PULHES system to rate functional capacity.³⁵ A bad cold with 48 hours of quarters is a DD Form 689 situation. A torn ACL with six months of running and rucking restrictions is a DA Form 3349 situation. The underlying medical fitness standards for both forms are in AR 40-501.⁶

1
Washington Headquarters Services. DD Form 689 Individual Sick Slip
2
Department of the Army. Army Regulation 40-66 Medical Services Medical Record Administration and Healthcare Documentation
3
21st Theater Sustainment Command. Guidance on Medical Profiles and Command Authorities
4
TRICARE. 96th Medical Group Warrior Operational Medicine Clinic Patient Guide
5
U.S. Army. DA Form 3349 Physical Profile Record
6
Army Publishing Directorate. Army Regulation 40-501 Standards of Medical Fitness