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The DD Form 2813 is a critical document utilized by the Department of Defense (DoD) to assess the dental health of service members, including those on active duty, as well as reserves and civilian personnel. This form primarily serves to collect essential patient information that helps determine an individual’s readiness for deployment. Filled out by dental professionals, it evaluates the oral health of members and identifies any conditions that might pose risks during their military duties. Questions about the individual's dental status range from their overall oral health to specific conditions that could lead to emergencies if neglected. Additionally, this form includes sections where dentists can note their findings, such as the need for treatment or the presence of urgent dental issues. The completion of the DD 2813 is voluntary, yet omitting information could lead to potential delays in assessing the member's dental needs for service. Understanding the importance and purpose of this form is crucial for service members and healthcare providers alike, as it directly impacts the readiness of military personnel to execute their duties effectively.

Dd 2813 Dental Example

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 when filled

CUI Category: PRVCY

 

LDC: FEDCON

 

POC: dha.ncr.bus-ops.mbx.dha-formsmanagement@mail.mil

Form Characteristics

Fact Name Description
Form Purpose The DD 2813 form is used to collect dental health information necessary to determine a service member's readiness for military deployment.
Governing Law This form is governed by several laws, including Public Law 104-191 (HIPAA) and various sections of Title 10 U.S.C, which pertains to medical and dental care for service members.
Submission Instructions It is crucial to remember not to return the completed form to the Department of Defense in Washington. Instead, follow your command’s instructions.
Voluntary Disclosure While completing the form is voluntary, failing to provide the requested information can lead to delays in assessing dental health for military duties.
OMB Approval The form has an OMB approval number (0720-0022), which indicates it complies with federal information collection requirements. Approval expires on January 31, 2023.
Information Use Data collected may be shared with other components within the Department of Defense and federal agencies for medical care and eligibility determinations.
Routine Uses Information on the form can be disclosed to private physicians and government agencies for public health compliance and healthcare recovery efforts.
Patient Evaluation The dentist evaluates whether the patient is fit for duty based on oral health and may identify conditions requiring immediate attention using specific criteria outlined on the form.

Guidelines on Utilizing Dd 2813 Dental

When preparing to fill out the DD Form 2813, it's important to gather all necessary information ahead of time. This will not only streamline the process but also ensure that the data you provide is accurate and complete. Following these straightforward steps will guide you through the form efficiently.

  1. Provide the service member's name: Fill in the last name first, followed by the first name, and include the middle initial.
  2. Enter the DoD ID number: Locate and write down the Department of Defense ID number of the service member.
  3. Select the branch of service: Indicate whether the member is in the Army, Navy, Air Force, Marines, or Coast Guard.
  4. Input the unit of assignment: Supply the name of the unit to which the service member is assigned.
  5. Fill in the unit address: Write the complete address for the unit of assignment, including street, city, state, and ZIP code.
  6. Record examination results: The examining dentist needs to check the appropriate block that describes the dental health condition based on exam results. Use the specific criteria provided on the form for guidance.
  7. Consult if X-rays were taken: Indicate if X-rays were consulted, and if so, provide the date they were taken in the specified format (YYYYMMDD).
  8. Provide the dentist’s name: Fill in the last name, first name, and middle initial of the examining dentist.
  9. Enter the dentist's telephone number: Include the area code, facilitating easy communication if necessary.
  10. Signature of the dentist: The examining dentist must sign the form to verify accuracy.
  11. Input the dentist's license number: Include the professional license number of the dentist who conducted the examination.
  12. Specify the date of examination: Record the date when the dental examination was performed in the format (YYYYMMDD).

What You Should Know About This Form

What is the DD 2813 Dental form used for?

The DD 2813 Dental form is utilized to assess a service member's dental health and readiness for military deployment. It collects important information regarding the individual's dental condition and helps ensure they can meet the dental standards required for active duty or deployment.

Who needs to fill out the DD 2813 form?

This form must be completed by a licensed dentist who examines the service member. The dentist will evaluate the dental health of the individual and determine if they meet the requirements for deployment without ready access to dental care.

What information is required on the DD 2813?

Essential details include the service member's name, DoD ID number, branch of service, unit assignment, and examination results. The form also requires the dentist’s name, contact information, license number, and the date of examination.

What are the examination results options on the DD 2813?

The form includes four options regarding the examination results. These range from having good oral health with no expected need for treatment in the next 12 months to various levels of oral conditions that may lead to dental emergencies if not addressed promptly.

What happens if a service member fails to provide the requested information on the DD 2813?

Failure to complete the form may lead to delays in assessing the service member’s dental health needs. This delay can affect their readiness for service and potential deployment.

Is completion of the DD 2813 form mandatory?

While completion is voluntary, it is strongly encouraged. Not providing the necessary information can hinder timely evaluation of dental health and readiness for military duties.

How is the information on the DD 2813 form used?

The information collected on the DD 2813 is shared within the Department of Defense to evaluate the service member’s readiness for deployment. It may also be shared with other agencies to determine eligibility for benefits and services.

What is the significance of the OMB number on the DD 2813?

The OMB number indicates that the form has been approved for use under federal regulations. It shows compliance with governmental reporting standards, ensuring that the collection of information does not impose unnecessary burdens on respondents.

What should a dentist do if they identify urgent dental conditions on the form?

If a dentist identifies conditions that could result in dental emergencies, they must note these on the form. This includes specific details about the identified conditions to ensure the service member receives timely dental care.

How long is the DD 2813 form valid once completed?

The information provided in the DD 2813 is relevant for a specific period, generally until the next examination, typically within 12 months. However, if dental issues arise sooner, reevaluation may be necessary.

Common mistakes

When filling out the DD 2813 Dental form, individuals often make mistakes that can complicate the process. One common error is failing to provide complete personal information. Each section requires specific details, including the service member's name, DoD ID number, and unit of assignment. Missing or incorrect information in these fields can lead to delays in processing and could affect eligibility for important benefits.

Another frequent mistake occurs in the examination results section. Some evaluators may not properly mark the appropriate box to reflect the patient's dental condition accurately. It's crucial to assess the patient's oral health thoroughly using the guidelines provided. An incomplete or inaccurate assessment can misrepresent a service member's readiness for duty, potentially impacting their deployment status.

People often overlook the requirement for the dentist's signature and license number. Some may think that a name in the dentist’s name field suffices, but without a proper signature and license details, the form may be considered invalid. This oversight can lead to further complications in verifying dental health status.

Errors can also occur regarding the date of examination. Not entering the examination date or using an incorrect format can result in confusion and delays. The specified format of YYYYMMDD must be adhered to strictly to ensure clarity and consistency in record keeping.

Many individuals fail to indicate whether X-rays were consulted. This information is significant for assessing dental health needs. If X-rays were taken, noting the date is equally critical. Leaving this section blank can raise questions about the thoroughness of the dental evaluation, which may lead to unnecessary follow-up procedures.

Finally, some people do not return the form to the correct address or follow the proper submission process. The instructions specifically state not to return the form to the organization mentioned at the top of the document. Failing to follow this directive can lead to the form being misplaced or not reaching the intended office, further delaying reviews and responses.

Documents used along the form

The DD 2813 Dental form is crucial for assessing the dental readiness of service members for military deployment. However, several other forms and documents often accompany it to facilitate the overall medical and administrative process. Below are five important documents that are typically used in conjunction with the DD 2813.

  • DD Form 2766: This form is a防医疗保障文件,记录了服务成员的医疗历史,包括重要的健康事项和医药过敏。在军队中,它通常用于确保医疗服务的连续性,尤其是在部署时期。
  • DD Form 214: The Certificate of Release or Discharge from Active Duty. This document summarizes a service member’s military career and provides essential information about their service status. It is often used to confirm eligibility for dental and medical benefits after service.
  • SF 600: The Chronological Record of Medical Care. This form is used to document a service member's medical history and treatments received. It provides a comprehensive view of an individual's health, which can be important for ongoing dental and medical assessments.
  • DA Form 3349: This is the Medical Condition–Permanent Profile form. It records the medical conditions that affect a service member's physical capabilities. Understanding these conditions is vital when evaluating dental needs related to military fitness duty.
  • TRICARE Enrollment Form: This document enrolls service members into the TRICARE health insurance system, facilitating access to dental and medical care. It helps streamline the process of obtaining necessary health services throughout a service member's career.

Understanding these accompanying documents is essential for ensuring that all aspects of a service member’s health are adequately managed. Together, they provide comprehensive information necessary for maintaining readiness and supporting the health of military personnel.

Similar forms

  • DD Form 2807-1 - This form is similar in that it collects medical history information necessary for assessing an individual's fitness for military service. Both forms provide critical data to ensure that service members meet health requirements before deployment.
  • SF 600 - The SF 600, or Chronological Record of Medical Care, tracks the ongoing medical care and evaluations received by a service member. Like the DD 2813, it is used to document health assessments that may affect readiness for duty.
  • DD Form 4 - Used for enlistment, DD Form 4 includes health questions that establish an individual’s eligibility for military service. Similar to the DD 2813, it plays a role in evaluating fitness for duty based on health status.
  • DA Form 3349 - This form records a service member's physical profile, which includes any medical conditions that may affect duty assignments. Like the DD 2813, it supports the determination of readiness based on health assessments.

Dos and Don'ts

When filling out the DD 2813 Dental form, it is essential to focus on accuracy and completeness. Here are five important guidelines to follow, along with some common pitfalls to avoid.

  • Ensure Accuracy: Double-check all patient details including names, identification numbers, and contact information to avoid errors.
  • Use Clear Language: Clearly describe dental conditions and findings. Avoid abbreviations that could lead to confusion.
  • Stay Updated: Make sure that all relevant regulations and guidelines are current and followed during the filling process.
  • Consult Prior Records: Review any previous dental records if available. This may provide insights that help in completing the form accurately.
  • Complete All Sections: Fill out every section thoroughly, including dates of examination and dentist information.
  • Avoid Hasty Filling: Rushing through the form can lead to mistakes that may require corrections later.
  • Don't Use Erasers: Avoid altering the form with erasures. Cross out any errors and write corrections clearly instead.
  • Do Not Leave Sections Blank: Leaving any part of the form incomplete might delay processing or assessments.
  • Skip the Instructions: Ignoring the provided instructions can result in misunderstanding what information is needed.
  • Do Not Submit Without Review: Always review the completed form before submission to ensure all information is accurate and complete.

Misconceptions

Misconceptions about the DD 2813 Dental form can lead to misunderstandings regarding its purpose and usage. Listed below are some common misconceptions along with explanations to clarify them.

  1. It is Mandatory for All Service Members. Many believe that filling out the DD 2813 is a blanket requirement for all service members. In reality, this form is specifically for those undergoing a dental examination to assess their readiness for deployment.
  2. It Only Applies to Active Duty Members. While the form is primarily geared towards active duty members, it also applies to reserve and guard members, as well as civilian personnel within the Department of Defense.
  3. Completing the Form Guarantees Dental Coverage. Some may think that merely submitting the DD 2813 guarantees dental treatment. This form only indicates dental fitness; it does not provide or guarantee access to dental care.
  4. The Provider Has No Role in the Process. Another misconception is that the dental provider simply fills out the form without any significant involvement. In fact, the form relies heavily on the dentist's clinical evaluation and judgment regarding the patient's dental health.
  5. It Is Only for Emergency Situations. Many assume that the DD 2813 is solely intended for emergency dental conditions. However, it is also used to assess general dental health and fitness for deployment, not just emergencies.
  6. X-rays Are Always Required. Some believe that all examinations must include X-rays. While X-rays can be helpful, they are not mandatory for every case and depend on the dentist's assessment.
  7. The Information Is Only for Internal Use. There is a misconception that the information on the form is only shared within the military. In truth, it may also be disclosed to other federal agencies to ensure appropriate medical care and benefits may continue.
  8. It's a One-Time Assessment. Some think that a completed DD 2813 suffices for all future assessments. However, dental conditions can change, and the form must be updated regularly based on the patient's current health status.
  9. Submission of the Form Is the End of the Process. Many believe that completing and submitting the form ends their obligations. In fact, failure to provide complete information can result in delays in medical evaluations, so ongoing communication with medical staff is crucial.

Understanding these misconceptions can help service members and their families navigate their dental health assessments more effectively. It is essential to communicate openly with dental providers and clarify any concerns regarding the form and its implications.

Key takeaways

Completing the DD 2813 Dental form is an important task that requires attention to detail. Here are some key takeaways to keep in mind:

  • Accurate Information: Ensure that all personal information, like name, DoD ID number, and branch of service, is correct. Mistakes can lead to processing delays.
  • Purpose of the Form: This form is used to assess the dental health of military members and determine their readiness for deployment. It is not intended for comprehensive dental care documentation.
  • Examination Requirements: A thorough clinical examination is necessary. The dentist should use a mirror, probe, and bitewing radiographs to evaluate the patient's dental health.
  • Conditions to Report: The dentist must identify any potential dental issues that may cause emergencies within the next 12 months. These conditions should be specified accurately on the form.
  • Submission Instructions: Do not return the completed form to the organization that provided it. Follow the instructions provided for submission to ensure it reaches the correct department.

Using the DD 2813 Dental form effectively ensures that military members maintain their dental readiness and can respond to deployment needs. Accuracy and thoroughness are key components for successful completion.