Medical Waiver Sample

STATE

LETTERHEAD

OFFICE SYMBOL

DATE

MEMORANDUM FOR ARNG Readiness Center, ATTN: NGB-ARS-H, 111 South George

Mason Drive, Arlington, VA 22204-1382

SUBJECT: Request for Medical Waiver, (RANK/Name/SSN)

1. (RANK/Name) has applied for a direct commission as a (RANK) in the Army Chaplain

Corps/Staff Specialist branch in the (STATE) Army National Guard.

2. The (CITY) Military Entrance Processing Station (MEPS) has recommended a waiver for

knee and ankle surgery that was performed approximately ten years ago. They also recommend

a waiver for an obstetrical procedure performed six years previously based on a current letter

from her present OB/GYN Doctor.

3. I have carefully reviewed all enclosed medical records and the current MEPS physical

pertaining to the waiver.

4. I strongly recommend approval.

NAME

RANK, BRANCH, XXARNG

State Surgeon

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Parent category: Medical