All requests for Med Hold orders must include the items below and be routed through the Command and District(dxr)/DOL-1/PAC-13 RFRS to CGPSC-RPM-3 via email to: ARL-SMB-CGPSC-RPM-Reserve-Medical@uscg.mil. All personnel involved in this process shall ensure proper precautions are taken to protection Personally Identifiable Information (PII) and Protected Health Information (PHII), especially when transmitting information electronically.

Initial Requests:

Initial requests must include ALL of the documents listed below. Incomplete request packages will be returned without action.

1. Signed Reserve Incapacitation Benefit Request Form.
2. A detailed Line of Duty Determination (LOD) shall be signed by the Commanding Officer and completed IAW Chapter 7 of the Administrative Investigations Manual, COMDTINST M5830.1(series) using one of the following methods:
   1. CG-3822: Injury Report
   2. Letter of Incident Report (LIR). For further information, please see Chapter 7 of COMDTINST M5830.1(series)     
3. All relevant medical documentation from Coast Guard, civilian or non-CG military treatment facilities.
4. Monthly Physician's Report Form - within 30 days of request submission and every 30 days thereafter
5. Signed Authorization for Disclosure of Medical or Dental Information, DD Form 2870.
6. A signed administrative remarks, CG-3307, (RIB-02)

NOTE 1: A formal LOD investigation is only required when the command has reason to believe that the injury, illness or disease was not incurred in the line of duty or occurred as a result of misconduct or gross negligence.

NOTE 2: The CG-4614 is obsolete. The Letter of Incident Report (LIR) should be utilized in its place.

Monthly Updates:

Member's on Med Hold orders are required to submit monthly supporting documentation to continue their benefits. Failure to submit the required monthly documentation below may result in early termination of benefits. All documents shall be submitted through the member's command and District(dxr)/DOL-1/PAC-13 RFRS to: ARL-SMB-CGPSC-RPM-Reserve-Medical@uscg.mil

1. Medical status updated are required at least once every 30-day period using the Monthly Physician's Report Form
2. All relevant medical documentation from Coast Guard, or non-military treatment facilities
3. Other supporting documentation as required by PSC-RPM

Extension Requests:

Med Hold orders may not be extended beyond the original date authorized by PSC-RPM-3 without prior approval from PSC-RPM-3. All extension requests must include the documentation below and be submitted to PSC-RPM-3 via email at: ARL-SMB-CGPSC-RPM-Reserve-Medical@uscg.mil

1. Reserve Incapacitation Benefit Request Form
2. Monthly Physician's Report Form - must be submitted every 30 days
3. All relevant medical documentation from Coast Guard, or non-military treatment facilities.

Upon RIB authorization, CGPSC-RPM-3 will updated the Medical Readiness Reporting System (MRRS) to show the member has a Deployment Limiting Condition (DLC). This action will change the member's medical DLC in CGBI to red to ensure the members are not mobilized involuntarily or voluntarily, until Available for Full Duty (AFFD) in accordance with Chapter 3 of the Reserve Policy Manual, COMDTINST M1001.28 (series).