g. DD Form 261 (Report of Investigation--Line-of-Duty and Misconduct Status) or
DA Form 2173 (Statement of Medical Examination and Duty Status), or a copy of
message to DA requesting line-of-duty determination (if applicable).
h. Statement of election relative to request for continuance on active duty and the
member's application for continuance (if applicable) (see figure 5-3).
i. Statement of retention beyond expiration of term of service, if applicable.
j. (If the patient is not on extended active duty), a copy of the orders to active duty,
active duty for training, or inactive duty training, of a copy of the orders rehospitalizing the
patient.
k. (In a mentally incompetent or deleterious-type case), a statement showing:
name, address, and relationship of next-of-kin (or court-appointed guardian); whether
patient is available for counseling following physical evaluation board action; and whether
patient has been advised that his case is being referred to the physical evaluation board. If
next-of-kin is not known or cannot be located and there is no court-appointed guardian, a
summary of attempts to identify and locate the next-of-kin must be provided.
l. Copy of request for a Veterans' Administration hospital bed designation (if
m. Copy of orders moving the patient to the Veterans' Administration hospital for
continued hospitalization (if applicable).
n. Copy of a letter(s) to appropriate State authority for disposition of a psychotic
member who is not eligible for Veterans' Administration hospitalization (if applicable).
o. (In case of member recently performing duty), a statement of commander or
rater concerning duty since medical condition alone will not support finding of unfitness.
MD0755
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