Soldier's Correct Full Name: __________________________________________
Soldier's Rank and Pay Grade: ________________________________________
Soldier's Social Security Number: ______________________________________
Soldier's Unit: _____________________________________________________
Soldier's Unit Address: ______________________________________________
Name of Exercise Soldier is on: ________________________________________
Full Name of Ill, Injured, or Deceased Person: _____________________________
Relationship of Person Shown Above to Soldier: ___________________________
What Hospital or Funeral Home Person is in: ______________________________
Who is the Doctor Treating the Person: __________________________________
Family Member who can Provide Additional Information: _____________________
Telephone Number: _________________________________________________
Family/Doctor Wants Soldier to:
Be Notified Only: _________
Come Home: _________
Leave Address Soldier Should Go To Is: ______________________________________
_____________________________________________________________________
Phone: (___)____________________________
Your Name: ____________________________________________________________
Your Address: __________________________________________________________
City/State/Zip: ___________________________________________________________
Phone Number: __________________________________________________________
The Soldier will Need About ________________ Days to Resolve the Problem
THE ABOVE INFORMATION
MAY HELP SPEED THE SERVICE MEMBER'S RETURN. IF YOU CONTACT A LOCAL RED CROSS OFFICE, BE SPECIFIC!
RED CROSS TOLL FREE IS: 1-877-272-7337
