DA Form 5018 R - Fill Out the ADAPCP Client Consent Statement

The DA 5018 R form, known as the ADAPCP (Army Drug and Alcohol Prevention and Control Program) Client's Consent Statement for Release of Treatment Information, is a critical document used within the U.S. Army. It serves the purpose of granting permission for the disclosure of an individual's treatment information related to alcohol or other drug abuse education, training, treatment, rehabilitation, or research. It outlines the consent process, sets the conditions for expiration or revocation of the consent, and details the authority for the release of information.

To ensure your privacy and rights are protected, it’s important to understand the DA 5018 R form thoroughly before consenting to the release of your treatment information. Click the button below to learn more about filling out the form.

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DA Form 5018-R PDF Details

The DA Form 5018 R, formally titled ADAPCP Client Consent Statement for Release of Treatment Information, protects the privacy of individuals enrolled in the Army's Alcohol and Drug Abuse Prevention and Control Program.

The form is divided into three sections. Section A captures the client's voluntary consent to disclose specific information, including diagnosis, prognosis, or treatment details, to named recipients. Section B defines when the consent expires and how the client may revoke it before that date. Clients involved with civilian criminal justice officials receive added protections under this section.

Section C establishes the approval authority. An authorized official must confirm that releasing the information does not harm the client before any disclosure occurs. This safeguard reflects the Army's commitment to client well-being and ethical healthcare practices.

Question	Answer
Form Name	DA Form 5018-R
Form Length	1 pages
Fillable?	Yes
Fillable fields	1
Avg. time to fill out	27 sec
Other names	da 5018 r fillable, da form 5018 r pdf, form adapcp form, da form 5018 r fillable

How to Edit DA Form 5018-R Online for Free

How to Fill Out DA Form 5018 R Online

Follow these steps to complete DA Form 5018 R using FormsPal's free PDF editor:

Open the form. Click the Fill Out Form button to launch the fillable DA Form 5018 R in your browser.
Enter client information. Add your full name, unit, and Social Security Number in Section A.
Name the authorized recipient. Specify the individual or organization authorized to receive your treatment information.
Select information type. Check the boxes for each type of information to be released: diagnosis, prognosis, treatment details, or rehabilitation progress.
Set expiration terms. Enter the date or event on which your consent expires, as required by Section B.
Sign and date. Read the consent statement carefully, then add your signature and the date of signing.
Download or print. Save the completed form as a PDF or print it for submission to your commanding officer.

Key Sections of the DA Form 5018 R

The form has three sections, each with a distinct purpose:

Section A - Consent Statement. Records the client's voluntary agreement to release named treatment information to specified parties.
Section B - Expiration and Revocation. Defines the consent expiration date and outlines the client's right to revoke consent at any time before that date.
Section C - Approval Authority. Requires an authorized official to confirm that the disclosure does not harm the client before any information is shared.

When to Complete DA Form 5018 R

Soldiers file the DA Form 5018 R when they need to share ADAPCP treatment records with approved parties. Common situations include coordination between Army medical personnel and civilian healthcare providers, transfers between Army units that require treatment continuity, and legal proceedings involving civilian criminal justice officials.

Related Army and Medical Consent Forms

After completing the DA Form 5018 R, you may also need the DA Form 5019-R for related ADAPCP program requirements. Soldiers managing general medical records may use the Medical Management Authorization Form. For substance abuse program documentation, see the Drug Testing Consent Form.