AF Form 1403: Roster of Seriously Ill/Very Seriously Ill

AF Form 1403: Roster of Seriously Ill/Very Seriously Ill – The AF Form 1403, officially titled “Roster of Seriously Ill/Very Seriously Ill”, serves as a critical administrative tool in the U.S. Air Force’s medical and casualty services framework. Patient Affairs personnel prepare this form using information provided by Inpatient Unit Officers to track and report on Airmen who are classified as Seriously Ill (SI) or Very Seriously Ill (VSI).

This roster supports timely notifications, family assistance, command oversight, and compliance with Air Force casualty and medical administration policies. It is particularly relevant for military treatment facilities (MTFs), medical groups, and casualty assistance teams across Active Duty, Air National Guard, and Air Force Reserve components.

What Is AF Form 1403 Used For?

AF Form 1403 creates an official roster of patients in a seriously or very seriously ill status. It consolidates key patient data for internal tracking, updates on condition changes, and support of broader casualty reporting requirements.

Medical authorities assign SI or VSI categories based on clinical assessment:

  • Very Seriously Ill/Injured (VSI): Death is probable, and it is more likely than not that the member could die within 72 hours. Permanent disability or death is a significant risk.
  • Seriously Ill/Injured (SI): Death is possible but not likely within 72 hours, or the condition involves permanent, life-altering injury/illness requiring extended hospitalization.

These definitions align with Department of Defense guidance and are detailed in Air Force casualty services processes. The form helps ensure rapid command notification, next-of-kin support, and coordination with programs like the Air Force Wounded Warrior (AFW2) or Warrior Care.

Note: The form is marked FOR OFFICIAL USE ONLY and must be protected in accordance with the Privacy Act of 1974. Unauthorized disclosure is prohibited.

Who Prepares and Uses AF Form 1403?

  • Primary Preparer: Patient Affairs section at military medical treatment facilities.
  • Information Source: Inpatient Unit Officers or medical providers who furnish patient details.
  • Users: Commanders, casualty assistance representatives (CARs), medical administrators, and higher headquarters for reporting and assistance coordination.
  • Related Roles: Often ties into processes under DAFI 36-3002, Casualty Services, which governs notifications for VSI, SI, and Not Seriously Ill/Injured (NSI) cases.

The form supports 24/7 casualty operations and ensures accurate, up-to-date rosters for leadership awareness.

Key Fields on AF Form 1403 (How to Complete It)

The form is straightforward and designed for ongoing updates. Here is a breakdown of the main sections based on the official template (AF Form 1403, dated 20230601, prescribed by AFMAN 41-210):

  • Column A – In-Unit Patient: Indicate the patient’s unit affiliation.
  • Column B – Name & Date: Enter the patient’s last name, first name, middle initial, along with relevant dates (e.g., admission or report date).
  • Column C – Pre-Grade: Record the patient’s grade/rank prior to the current condition.
  • Column D – EDOD ID: Enter the Electronic DoD ID (EDIPI) number.
  • Column E – Reported Condition: Provide a description of the illness or injury as reported by medical staff.
  • Columns F/G/H/I – Condition Status: Mark whether the condition has Worsened, remained Unimproved, Changed, or Improved. Include update dates.
  • Remarks: Add any additional notes, religious preferences (if applicable), or coordination details.
  • Other Fields: Some versions include space for religious affiliation or further administrative notes.

Patient Affairs compiles the roster from inpatient data. Updates are entered as the patient’s condition evolves (e.g., daily or as changes occur). Previous editions of the form remain usable.

Download the Official AF Form 1403:

Always use the version hosted on e-Publishing.af.mil for the most compliant template.

AF Form 1403 operates within the larger framework of Air Force casualty and medical administration:

  • DAFI 36-3002, Casualty Services — Primary instruction for notifications, reporting, and assistance for VSI/SI cases. It outlines commander responsibilities, use of the Defense Casualty Information Processing System (DCIPS), and family travel support.
  • AFMAN 41-210 — Prescribes the form and provides guidance on medical administration.
  • DAFI 34-1101 — Covers non-medical support to seriously and very seriously ill/injured Airmen, including Warrior Care programs and enrollment criteria.

Commanders or designees must ensure timely reporting. In many cases, casualty reports feed into automated systems for higher-level notification. Overseas or CONUS incidents may have slightly different timelines, but the goal remains consistent: rapid, accurate information flow to support the Airman and family.

For Air Reserve Component (ARC) members, additional considerations apply under medical continuation orders or incapacitation pay when the illness/injury occurs in a duty status.

Why Accurate Use of AF Form 1403 Matters?

Proper completion and maintenance of this roster:

  • Enables timely next-of-kin notifications and emergency family member travel.
  • Supports medical case management and transition to programs like AFW2 for long-term recovery.
  • Ensures compliance with DoD and Air Force privacy and casualty policies.
  • Helps prevent gaps in command awareness during critical health events.

Medical providers determine the SI/VSI status. Patient Affairs then builds and updates the roster. Errors or delays can impact family support and mission readiness.

Tips for Air Force Medical and Administrative Personnel

  1. Verify all patient data (especially DoD ID and unit) against official records.
  2. Update the roster promptly when a patient’s condition improves, worsens, or changes.
  3. Coordinate with the servicing Casualty Assistance Representative for any required DCIPS entries.
  4. Store and transmit the form securely per Privacy Act and For Official Use Only (FOUO) rules.
  5. Reference the latest DAFI 36-3002 for full notification workflows, as policies are periodically updated.

For the most current guidance, consult the official publications on the Air Force e-Publishing website (e-publishing.af.mil) or contact your local Medical Group Patient Affairs or Casualty Services office.

Need the Form or More Help?

  • Official Download: AF Form 1403 PDF
  • Search for related instructions using keywords like “DAFI 36-3002 Casualty Services” on e-publishing.af.mil.

This guide is based on official Air Force sources as of 2026, including the current form template and supporting Department of the Air Force Instructions. Always cross-reference with the latest publications, as forms and instructions can receive updates. If you are a service member, dependent, or commander dealing with a serious illness situation, reach out to your installation’s Casualty Services or Patient Affairs team for personalized assistance.

Keywords: AF Form 1403, Roster of Seriously Ill, Very Seriously Ill Air Force, AF Form 1403 PDF, DAFI 36-3002, Air Force casualty services, SI VSI reporting, Patient Affairs roster.