Air force dental form 2813 dd form 2813 pdf

Active duty dental program appointment of appeal representative active duty service members in remote locations may appeal click to close the action you take if you dont agree with a decision made about your benefit. Air force dental form fill out and sign printable pdf. This form should be completed by the dtf or civilian provider and will be used to assist the services in documenting member dental health. A fillable copy of the dd form 28 can be downloaded below or can be supplied through the chain of command. Dd form 28, active dutyreserve forces dental examination the government requires all active. Dd form 28 fill online, printable, fillable, blank.

Tools get an email when your favorite publication or form changes. The dd 28 dental form is filled out both by the soldier receiving the dental examination and by the dentist providing it you must bring the form with you to the examination and hand it to. Fillable dd form 28 department of defense active duty. The information in this letter will be incorporated into ar 4035 and ar4066. A dd form 28 is a department of defense form is used for gathering dental information for military members who will spend an extended period of time away from dental services. Laws calm legal forms guide a dd form 28 is a department of defense form used for gathering dental information for military members who will spend an extended period of time away from dental services the form is used by military physicians to determine if an applicant is fit for extended service away from dental help the dd form 28 is. Dd form 28 active duty reserve forces dental examination.

Dd form 28 active duty reserve forces dental examination a dd form 28 is a department of defense form is used for gathering dental information for military. Download free printable army dental examination form samples in pdf, word and excel formats. Dd form 28 guard reserve dental readiness classification the dd form 28, dod active dutyreserve forces dental examination, will be used to assist the tdpenrolled national guardreserve forces in documenting. If the form number does not have a hyperlink, the form is not available electronically. The examination form often incorrectly referred to as the da form 28 was revised by the department of defense dod in march 20. Dd form 28 department of defense active dutyreserveguardcivilian forces dental examination is a form used for gathering dental information on. This form is meant to determine fitness for prolonged duty without ready access to dental care and is not intended to address the members comprehensive dental needs. The examination results documented on the dd 28 form help military physicians determine if a soldier is fit for extended service away from dental help. Dutyreserve guardcivilian forces dental examination form dd form 28. Educational materials military dental forms please note. Dd form 28, active dutyreserve forces dental examination, october 20 author. When revisions to these publications are published, those revisions will aspersed this letter.

Dd form 28 guard reserve dental readiness classification the dd form 28, dod active dutyreserve forces dental examination, will be used to assist the tdpenrolled national guardreserve forces in documenting member dental. Army dental examination form 1 free templates in pdf. Forms dd28071 report of medical history, dd2808 report. Active dutyreserve forces dental examination form approved omb no. Get a copy of dd form 214 certificate of discharge from. Only the claim form should be used to submit claims. Dd28 department of defense active dutyreserve forces. Dd form 28, dod active dutyreserve forces dental examination you must complete blocks 15 prior to reporting to phfhm blocks 611 will be completed by an mtf dental provider e. Download it as a pdf or print a copy for your reference. Health protection to preventive dentistry and dental readiness cover. Fill, sign and download army dental examination form online on. Air force dental form fill out and sign printable pdf template.

Dd28 dental form omb no 07200022 omb approval expires. Fillable and printable army dental examination form 2020. Print content only for preprinted forms 12321 type. Links to important forms for the active duty dental program. Dd form 28 applies to members of the examinations performed by civilian dentists. Dd forms 20002499 washington headquarters services. Dd form 877, request for medical or dental records or information, september 1967. This form is meant to determine fitness for prolonged duty without ready access to dental care and is not. Dd form 25002999 executive services directorate washington. Military dental exams are required every three years dd form 28 completed by civilian dentist dd form 28 must be turned in to the servicing active duty dental facility to update the corporate dental system cds and dental records. This letter prescribes the use of a new form dd form 28 department of defense reserve forces dental examination. Services information technology operations support, 912002, no, air force. Department of defense force health protection policy requires the services to conduct annual health assessments of military personnel, including individual medical readiness imr assessments.

Medical services preventive dentistry and dental readiness. Download a blank fillable dd form 28 department of defense active duty reserve forces dental examination in pdf format just by clicking the download pdf button. Dd form 28 completed by civilian dentist dd form 28 must be turned in to the servicing active duty dental facility to update the corporate dental system cds and dental records. Dental caries or fractures with moderate or advanced extension into dentin. Registration window closes 3 business days prior to the training date. Adobe reader or any alternative for windows or macos are required to access and complete fillable content. View, download and print fillable dd 28 department of defense active dutyreserve forces dental examination in pdf format online. The active duty dental program privacy act statement.

Dd form 28071, report of medical history, completed and signed d. The form is used by military physicians to determine if an applicant is fit for extended service away from dental help. Dd2870, authorization for disclosure of medical or dental information, 1212003, no, dha. Dd form 28 guard reserve dental readiness classification the dd form 28, dod active dutyreserve forces dental examination, will be used to assist the tdpenrolled national guardreserve forces in documenting member dental health. Dd form 28, active dutyreserve forces dental examination. Collection of information, including suggestions for reducing the burden, to department of. Remember, it can take a long time to get your document replaced, so take care of it. Click here to submit a claim online via speed eclaim.

This form should be completed by the dtf or civilian provider and will be used to assist the services in. You can find more information about replacing your dd form 214, including which forms you will need to send to the national personnel records center, at the national archives website. Dental readiness you must complete an annual dental exam if youre a member of the national guard and reserve. Dd form 28 download fillable pdf or fill online department of. Dd28, department of defense active dutyreserveguardcivilian forces dental examination. To collect information necessary for completion of your dental readiness examination conducted by a dental provider and to collect information necessary for the dental provider to submit a claim for payment for the dental services provided to you.

Having trouble downloading pdf files or with the pdf editor. By downloading this form you agree to the tos and form community agreement. If youre in the tricare dental program, network dentists can complete the dental exam form for you at no cost you will have to. Medical services preventive dentistry and dental readiness army regulation 4035 effective 21 august 2016. To obtain hard copies of current forms not available in electronic format, please contact your own military service or dod component forms management officer. Department of defense active dutyreserve forces dental examination. Active dutyreserveguardcivilian forces dental examination. Secaf redesignation of air force space command to united states space force. The dd form 28, dod active dutyreserve forces dental examination, will be used to assist the tdpenrolled national guardreserve forces in. 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.