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. Dd form 28071, report of medical history, completed and signed d. Dd form 25002999 executive services directorate washington. Dental readiness you must complete an annual dental exam if youre a member of the national guard and reserve. Active dutyreserve forces dental examination the government requires all active duty and reserve members receive an annual dental examination. Download it as a pdf or print a copy for your reference. Links to important forms for the active duty dental program.
Tools get an email when your favorite publication or form changes. Dd2870, authorization for disclosure of medical or dental information, 1212003, no, dha. Dd form 28 download fillable pdf or fill online department of. Department of defense force health protection policy requires the services to conduct annual health assessments of military personnel, including individual medical readiness imr assessments. Services information technology operations support, 912002, no, air force. This letter prescribes the use of a new form dd form 28 department of defense reserve forces dental examination. 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. It is the most important military document you have. If youre in the tricare dental program, network dentists can complete the dental exam form for you at no cost you will have to. Dd form 28, active dutyreserve forces dental examination. 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. Registration window closes 3 business days prior to the training date. 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.
If the form number does not have a hyperlink, the form is not available electronically. 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. 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. Medical services preventive dentistry and dental readiness.
The information in this letter will be incorporated into ar 4035 and ar4066. 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. Air force dental form fill out and sign printable pdf. This form is meant to determine fitness for prolonged duty without ready access to dental care and is not. Air force dental form fill out and sign printable pdf template.
Dd form 877, request for medical or dental records or information, september 1967. Forms dd28071 report of medical history, dd2808 report. 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. Dd28 dental form omb no 07200022 omb approval expires. When revisions to these publications are published, those revisions will aspersed this letter.
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. 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. Army dental examination form 1 free templates in pdf. 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. Secaf redesignation of air force space command to united states space force.
Dd form 28 fill online, printable, fillable, blank. This form should be completed by the dtf or civilian provider and will be used to assist the services in documenting member dental health. Dd form 28, active dutyreserve forces dental examination the government requires all active. Fillable dd form 28 department of defense active duty. Having trouble downloading pdf files or with the pdf editor. Download free printable army dental examination form samples in pdf, word and excel formats. Dd form 28 department of defense active dutyreserveguardcivilian forces dental examination is a form used for gathering dental information on. You are here home legal forms department of defense dd forms dd28 department of defense active dutyreserve forces dental examination form categories citizenship and immigration services uscis. This form should be completed by the dtf or civilian provider and will be used to assist the services in. To obtain hard copies of current forms not available in electronic format, please contact your own military service or dod component forms management officer. Dd form 28 active duty reserve forces dental examination. Dd28, department of defense active dutyreserveguardcivilian forces dental examination. Dental caries or fractures with moderate or advanced extension into dentin. Go dd form 28 e pubs dd form 28 guard reserve dental readiness.
Dd forms 20002499 washington headquarters services. A fillable copy of the dd form 28 can be downloaded below or can be supplied through the chain of command. The dd form 28, dod active dutyreserve forces dental examination, will be used to assist the tdpenrolled national guardreserve forces in. Dd28 department of defense active dutyreserve forces. Click here to submit a claim online via speed eclaim. 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. Fill, sign and download army dental examination form online on.
Educational materials military dental forms please note. View, download and print fillable dd 28 department of defense active dutyreserve forces dental examination in pdf format online. Fillable and printable army dental examination form 2020. Active dutyreserve forces dental examination form approved omb no. Medical services preventive dentistry and dental readiness army regulation 4035 effective 21 august 2016. The examination form often incorrectly referred to as the da form 28 was revised by the department of defense dod in march 20.
Health protection to preventive dentistry and dental readiness cover. Only the claim form should be used to submit claims. 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. 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. The active duty dental program privacy act statement. Get a copy of dd form 214 certificate of discharge from. 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. Print content only for preprinted forms 12321 type. Dd form 28, active dutyreserve forces dental examination, october 20 author. Dutyreserveguardcivilian forces dental examination form dd form 28. Adobe reader or any alternative for windows or macos are required to access and complete fillable content. By downloading this form you agree to the tos and form community agreement. Remember, it can take a long time to get your document replaced, so take care of it. 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.
Active dutyreserveguardcivilian forces dental examination. Collection of information, including suggestions for reducing the burden, to department of. Dd form 28 applies to members of the examinations performed by civilian dentists. Dutyreserve guardcivilian forces dental examination form dd form 28. Department of defense active dutyreserve forces dental examination.