The DD Form 2813, also known as the Department of Defense Reserve Forces Dental Examination form, serves a key role in assessing the dental health and readiness of members of the U.S. Armed Forces Reserve components. This crucial document is designed to evaluate whether a service member has dental conditions that could limit their ability to perform duty, especially when deployed to areas without immediate dental care. For Guard and Reserve members, completing this form is a step toward ensuring their readiness and fitness for extended duty. Interested in ensuring your dental readiness? Click the button below to fill out your form.
The DD 2813 form, officially titled "Department of Defense Reserve Forces Dental Examination," serves a critical role within the military health system, particularly for members of the Guard and Reserve components of the United States Armed Forces. This document, approved by the Office of Management and Budget (OMB No. 0720-0022) and with an expiration date of December 31, 2002, is designed to facilitate a comprehensive assessment of a service member's dental health. It underscores the importance of readiness by ensuring that individuals are fit for prolonged duty without the immediate availability of dental care. The form requires a dentist's evaluation of the service member's oral health, identifying any conditions that could potentially lead to dental emergencies within a 12-month period if left untreated. Conditions assessed range from infections and caries/restorations to missing teeth, periodontal conditions, oral surgery needs, and other relevant dental issues. The process outlined for completing and reviewing this information not only strives to minimize the impact of dental emergencies on service members' duties but also highlights the broader commitment of the Department of Defense to maintain the health and readiness of its personnel. By facilitating early detection and treatment of potential dental issues, the DD 2813 form plays a vital role in ensuring that service members are always ready to fulfill their duties, reflecting a key aspect of military preparedness.
CUI when filled
DEPARTMENT OF DEFENSE ACTIVE DUTY/RESERVE/GUARD/CIVILIAN FORCES DENTAL EXAMINATION
OMB No. 0720-0022 OMB approval expires 20230131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod- informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.
AUTHORITIES: Public Law 104-191, Health Insurance Portability and Accountability Act of 1996; 10 U.S.C., Chapter Ch. 55, Medical and Dental Care; 10 U.S.C.
1097a, TRICARE Prime: Automatic Enrollments; Payment Options; 10 U.S.C. 1097b, TRICARE Prime and TRICARE Program: Financial Management; 10 U.S.C.
1079, Contracts for Medical Care for Spouses and Children: Plans; 10 U.S.C. 1079a, TRICARE Program: Treatment of Refunds and Other Amounts Collected Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); 10 U.S.C. 1086, Contracts for Health Benefits for Certain Members, Former Members, and Their Dependents; 10 U.S.C. 1095, Health Care Services Incurred on behalf of Covered Beneficiaries: Collection From Third-party Payers; 42 U.S.C. 290dd-2, Confidentiality Of Records; 42 U.S.C 42 U.S.C. Ch. 117, Sections 11131-11152, Reporting of Information; 45 CFR 164, Security and Privacy; Department of Defense (DoD) Instruction 6015.23, Foreign Military Personnel Care and Uniform Business Offices in Military Treatment Facilities (MTFS); DoD 6025.18-R, DoD Health Information Privacy Regulation; and E.O. 9397 (SSN).
PURPOSE: To collect patient information necessary to determine the patient’s readiness to participate in a military deployment.
ROUTINE USES: Information in your records may be disclosed to other components within the Department of Defense to determine your readiness to participate in a military deployment. Information in your records may also be disclosed to private physicians and Federal agencies, including the Departments of Veterans Affairs, Health and Human Services, and Homeland Security in connection with your medical care; other federal, state, and local government agencies to determine your eligibility for benefits and entitlements and for compliance with laws governing public health matters; and government and non-government third parties to recover the cost of healthcare provided to you by the Military Health System. Any protected health information (PHI) in your records may be used and disclosed generally as permitted by the HIPAA Rules, as implemented within DoD. Permitted uses and disclosures of PHI include, but are not limited to, treatment, payment, and healthcare operations.
APPLICABLE SORN: EDHA 07, “Military Health Information System,” (June 15, 2020, 85 FR 36190) https://dpcld.defense.gov/Portals/49/Documents/Privacy/ SORNs/DHA/EDHA-07.pdf
DISCLOSURE: Voluntary. However, failure to provide the information requested may result in delays in assessing your dental health needs for military service and/or for possible deployment.
1. SERVICE MEMBER'S NAME (Last, First, Middle Initial)
2. DoD ID Number
3. BRANCH OF SERVICE
4. UNIT OF ASSIGNMENT
5. UNIT ADDRESS
6.EXAMINATION RESULTS Dear Doctor,
The individual you are examining is an Active Duty/Guard/Reserve/Civilian member of the United States Armed Forces. This member needs your assessment of his/her dental health for worldwide duty. Please mark (X) the block that best describes the condition of the member, using as a suggested minimum a clinical examination with mirror and probe, and bitewing radiographs. This form determines fitness for prolonged duty without ready access to dental care and is not intended to document comprehensive dental needs.
(1)Patient has good oral health and is not expected to require dental treatment or reevaluation for 12 months
(2)Patient has some oral conditions, but you do not expect these conditions to result in dental emergencies within 12 months if not treated (i.e., requires prophylaxis, asymptomatic caries with minimal extension into dentin, edentulous areas not requiring immediate prosthetic treatment).
(3)Patient has oral conditions that you do expect to result in dental emergencies within 12 months if not treated.
Examples of such conditions are: (X the applicable block or specify in the space provided)
(a)Infections: Acute oral infections, pulpal or periapical pathology, chronic oral infections, or other pathologiclesions and lesions requiring biopsy or awaiting biopsy report.
(b)Caries/Restorations: Dental caries or fractures with moderate or advanced extension into dentin; defective restorations or temporary restorations that patients cannot maintain for 12 months.
(c)Missing Teeth: Edentulous areas requiring immediate prosthodontic treatment for adequate mastication, communication, or acceptable esthetics.
(d)Periodontal Conditions: Acute gingivitis or pericoronitis, active moderate to advanced periodontitis, periodontal abscess, progressive
mucogingival condition, moderate to heavy subgingival calculus, or periodontal manifestations of systemic disease or hormonal disturbances.
(e)Oral Surgery: Unerupted, partially erupted, or malposed teeth with historical, clinical, or radiographic signs or symptoms of pathosis that are recommended for removal.
(f) Other: Temporomandibular disorders or myofascial pain dysfunction requiring active treatment.
(4) If you selected Block (3) above, please indicate the condition(s) you identified in this patient if they appear above, or briefly describe the condition(s) below:
(5) Were X-rays consulted?
IF YES, DATE X-RAY WAS TAKEN (YYYYMMDD)
7. DENTIST'S NAME (Last, First, Middle Initial)
8. DENTIST'S TELEPHONE NUMBER (Include Area Code)
9. DENTIST'S SIGNATURE
9. DENTIST'S LICENSE NUMBER
10. DATE OF EXAMINATION (YYYYMMDD)
DD FORM 2813, NOV 2021
PREVIOUS EDITION IS OBSOLETE.
Controlled by: DHA
CUI Category: PRVCY
LDC: FEDCON
POC: dha.ncr.bus-ops.mbx.dha-formsmanagement@mail.mil
Filling out the DD Form 2813, or the Department of Defense Reserve Forces Dental Examination form, is a critical step in ensuring service members are ready for deployment by assessing their dental health. The form provides an overview of a member's dental condition, which helps in determining their fitness for duty without immediate access to dental care. The process of completing this form involves a dental professional's evaluation and documentation of any dental issues that could affect the member's ability to perform. Here’s how you can fill out the form efficiently and accurately.
By following these steps, you will ensure the DD Form 2813 is completed thoroughly and accurately, facilitating a smooth process in assessing and documenting the dental health of service members. Remember, timely and precise completion of this form plays an essential role in maintaining the operational readiness and overall well-being of the forces.
What is the DD 2813 form?
The DD 2813 form is an official document from the Department of Defense. It's used to record the dental health examination results for members of the Reserve Forces. Dentists complete the form after examining these service members to determine their fitness for duty without access to dental care for a prolonged period.
Who needs to fill out the DD 2813 form?
This form is meant for dentists who are examining members of the United States Guard/Reserve Forces. The service members need this assessment to ensure their dental health is adequate for worldwide duty, which might not have easy access to dental care facilities.
What is the main purpose of the DD 2813 form?
The principal purpose of the DD 2813 form is to provide an assessment of a service member's dental health. This assessment is crucial for determining their readiness and fitness for deployment or prolonged duty where there might not be immediate access to dental care. This evaluation helps in avoiding dental emergencies that could affect their service.
What information is required on the DD 2813 form?
The form requires the service member's name, social security number, branch of service, unit of assignment, and unit address. It also needs the examination results, which include the dentist's observations and any indications of dental conditions that could lead to emergencies within 12 months. Additionally, the dentist's name, address, phone number, and signature, along with the date of the examination, must be provided.
Are X-rays required when completing the DD 2813 form?
X-rays are not mandatory for all dental examinations but are recommended as part of the clinical examination with mirror and probe. If X-rays are consulted, the form has a section to indicate this by checking "YES" and providing the date the X-ray was taken.
What happens if a service member fails to provide the necessary information?
Failure to furnish the required information on the DD 2813 form can result in delays in assessing the dental health needs of the service member. This delay might affect their readiness and eligibility for deployment or fulfilling duties as required by their service commitment.
Where should the completed DD 2813 form be sent?
Contrary to the address listed for providing comments about the form, the completed DD 2813 should not be returned to the above-mentioned address. Instead, it should be submitted to the appropriate military department or unit that requested the dental examination. The exact submission process can vary, so service members or examining dentists should verify with the specific branch or unit.
What is the significance of the OMB No. and expiration date on the form?
The Office of Management and Budget (OMB) number indicates that the form has been approved for use and the collection of information is authorized. The expiration date, which in this instance was December 31, 2002, suggests when the form's approval expires. However, forms are often used beyond their expiration date until a new version is issued. It's vital to use the most current form when completing the examination to ensure compliance with Department of Defense requirements.
Filling out the DD 2813 form, the Department of Defense Reserve Forces Dental Examination form, requires attention to detail and specificity. However, mistakes frequently occur which can lead to inaccuracies or even delays in processing. One common error is the mishandling of personal information. Specifically, service members or dentists might incorrectly fill in the service member’s name, Social Security Number, or branch of service. This seemingly simple step is crucial for the identification of the service member and ensuring that their dental examination records are accurately matched with their service profile.
Another mistake involves the examination results section. Often, individuals may rush through this part, not marking the appropriate condition box that accurately reflects the member's dental health. This action could lead to misinterpretation of a service member's readiness and potentially impact their fitness for duty assessment. The form is structured to capture specific dental conditions that could affect a service member's deployment capability, thus accurate completion is vital.
Additionally, failure to indicate whether X-rays were consulted is a common oversight. This detail is essential since X-rays can provide critical information regarding a patient's oral health that a visual examination might miss. If X-rays are consulted, it is equally important to accurately note the date on which they were taken to ensure the dental assessment reflects the most current state of the service member’s oral health.
The dentist's information section is another area prone to errors. Dentists or their administrative personnel may inadvertently input incorrect contact information, including the address or telephone number. Such inaccuracies can cause significant delays should any follow-up be necessary, especially if the form needs to be returned for corrections or additional information is required to assess the member's dental health.
Finally, the omission of the dentist's signature and the date of examination is a surprisingly frequent mistake. Without these, the form is considered incomplete and cannot be processed, leading to potential delays in the service member’s deployment or assignment. The signing of the form verifies that the dental assessment was performed and asserts the accuracy of the information provided.
The DD Form 2813, also known as the Department of Defense Reserve Forces Dental Examination, is essential for assessing the dental health of Guard/Reserve members in the United States Armed Forces, determining their fitness for duty without ready access to dental care. In addition to this form, there are various other forms and documents often used alongside it to ensure comprehensive health and readiness assessments for military service members. Among these, some serve general health evaluation purposes, while others focus on more specific aspects of the servicemember's health and readiness.
Together with the DD Form 2813, these documents create a comprehensive framework for managing the health and readiness of military service members, ensuring they are physically and mentally prepared for their duties and the challenges of deployment. Proper completion and timely submission of these forms are vital for maintaining the effectiveness and readiness of the Armed Forces.
The DD 2813 form, designed for assessing the dental health of United States Armed Forces Guard/Reserve members, bears a resemblance to the DD Form 2807-1, "Report of Medical History." This form is used by military members to document their medical history for a variety of purposes, including initial entry, flight status, and special operational duties. Similar to the DD 2813, the DD 2807-1 collects health information that impacts a service member’s readiness but focuses on overall medical history rather than specific dental health assessments. Both forms play crucial roles in ensuring that individuals are physically fit for their designated duties.
Another related document is the DD Form 2808, "Report of Medical Examination." Used in conjunction with the DD Form 2807-1, this form records the findings of a physical medical examination conducted by a healthcare provider. The DD Form 2808 is comprehensive, covering a wide range of physical examinations including visual acuity, hearing tests, and general physical condition, similar to how the DD 2813 covers dental examinations. Both of these forms are essential for a complete evaluation of a military member's health and readiness for service, albeit the DD Form 2808 encompasses a broader scope beyond dental health.
The Standard Form 88 (SF-88), "Report of Medical Examination," historically served a similar purpose to that of the DD Form 2808, offering a detailed account of an individual’s medical evaluation. Although largely obsolete and replaced by the DD Form 2808, the SF-88 was pivotal in determining the physical fitness of military personnel for duty, akin to the role played by the DD 2813 in assessing dental fitness for service. Both the SF-88 and DD 2813 underscore the importance of thorough health screenings in maintaining operational readiness within the military.
Lastly, the Standard Form 600 (SF-600), "Health Record – Chronological Record of Medical Care," is akin to the DD 2813 in that it serves as an ongoing record of an individual's medical treatment over time. While the SF-600 is more general and tracks a variety of medical encounters and observations, the DD 2813 specifically records the results of a dental examination. Both are vital for documenting the health status and medical interventions received by an individual, ensuring that healthcare professionals have access to historical data that may influence treatment decisions and fitness evaluations.
Filling out the DD Form 2813, the Department of Defense Reserve Forces Dental Examination form, requires careful attention to detail to ensure that the information provided is accurate and complete. This form plays a crucial role in assessing the dental health of Guard and Reserve members of the United States Armed Forces, with implications for their readiness for duty. Here are several dos and don'ts to keep in mind when completing this form:
Proper completion of the DD Form 2813 helps in accurately determining a service member’s dental health status and readiness for duty. It's essential not only for the individual's well-being but also for maintaining the operational effectiveness of the Armed Forces.
The DD Form 2813, or the Department of Defense Reserve Forces Dental Examination form, plays a pivotal role in assessing the dental health of reserve members of the U.S. Armed Forces. However, there are numerous misconceptions surrounding its use, importance, and implications. Let's clarify some of these misunderstandings:
Only active-duty members require dental assessments. Contrary to this belief, both active duty and reserve forces are required to undergo dental evaluations. The DD Form 2813 specifically caters to reserve members, ensuring they are also fit for duty.
The form is complicated and time-consuming. Though it appears intricate, the DD Form 2813 is designed for efficiency. The estimated time to complete it is roughly 3 minutes, emphasizing its straightforward nature.
It mainly serves for deployment purposes. While ensuring readiness for deployment is a crucial aspect, the form's broader aim is to assess the overall dental health for the next 12 months, irrespective of deployment status.
Any dentist can sign off on the form. While it's true that any licensed dentist can complete the form, the dentist must understand the specific dental standards required by the military, which may differ from civilian dental assessments.
The form grants immediate access to military dental care. Submitting the DD Form 2813 does not guarantee immediate dental treatment by military dental facilities. It primarily assesses fitness for duty without easy access to dental care.
Completion of the form exempts members from further dental checks. Even with a completed DD Form 2813, service members may still be subject to additional dental screenings or treatment based on their overall health assessments and mission requirements.
Dental X-rays are always required. Though X-rays can provide valuable information, they are not always necessary for completing the DD Form 2813. Whether X-rays are consulted depends on the dentist's judgment and the member's specific dental condition.
A negative report leads to immediate dismissal from duty. A report indicating dental issues doesn't automatically disqualify a member from service. Instead, it identifies the need for possible dental interventions to ensure readiness for duty.
The form is only concerned with current dental problems. Besides identifying existing dental issues, the form aims to predict potential dental emergencies, ensuring members can fulfill their duties without unexpected interruptions due to dental health issues.
Privacy is not a concern while handling the DD Form 2813. The form includes a Privacy Act Statement, underscoring the military's commitment to protecting the personal information of its members. Privacy considerations are integral to the process.
Understanding the facts about the DD Form 2813 demystifies its purpose and highlights its importance in maintaining the dental health and readiness of reserve forces in the U.S. Armed Forces. Clearing up these misconceptions encourages a smoother, more informed process for all involved parties.
Filling out and using the DD Form 2813, also known as the Department of Defense Reserve Forces Dental Examination form, is crucial for members of the Guard/Reserve of the United States Armed Forces. This form helps in assessing the dental health of service members, ensuring they are fit for prolonged duty without ready access to dental care. Here are four key takeaways about filling out and using this form:
Understanding these key aspects of the DD Form 2813 is essential for service members and dental professionals alike, ensuring that the form is filled out accurately and used effectively to maintain the readiness and health of those serving in the Guard/Reserve of the United States Armed Forces.
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