DA Form 8003 at a glance
What it is: DA FORM 8003, MAY 2018 is the COMMAND REFERRAL FOR A SUBSTANCE USE DISORDER (SUD) EVALUATION.
Who signs: SIGN 13. Commander's Signature and Provider Signature:
A filled-in DA Form 8003 example: a commander refers a Service member after a positive UA
How to fill out DA Form 8003, box by box
1. Name, 2. Rank/Grade, 3. DOD ID., 4. DOB and 5. Unit
Enter 1. Name (Last, First, MI), 2. Rank/Grade, 3. DOD ID. and 4. DOB (YYYYMMDD).
Enter 5. Unit.
6. Depart installation, 7. Flying status and 8. Personnel Reliability Program
Enter NO or YES for 6. Is the Service member expected to depart installation within 90 days?, 7. Is Service member on flying status? and 8. Is Service member involved in Personnel Reliability Program?
9. Reason for Referral
The Service member named is being referred to behavioral health (BH) for a comprehensive SUD assessment to determine if the individual meets criteria for enrollment into mandatory SUD treatment. IAW 600-85, command must refer all Service members with a positive UA or an alcohol-related incident for evaluation within 5 days. Service members not involved in an alcohol or drug related incident (including a positive UA) may self-refer to their assigned BH clinic for a SUD assessment; command referral is not necessary in these cases.
Under 9. Reason for Referral, enter Positive UA/Biochemical (Type Drug) or Drug/Alcohol-Related Incident (Type of incident).
10. Record of Civilian Arrests/Convictions, Courts Martial, Company Punishments, and Disciplinary Problems
Enter in 10. Record of Civilian Arrests/Convictions, Courts Martial, Company Punishments, and Disciplinary Problems, including those pending: (Specific dates and offenses).
11. Performance
Under 11. Performance, Performance/Efficiency: is Excellent, Good, Fair or Unsatisfactory.
Under 11. Performance, Behavioral/Conduct: is Excellent, Good, Fair or Unsatisfactory.
12. Other Problems
Under 12. Other Problems, mark Financial, Marriage/Family, Medical or Other (specify):.
13. Commander's Signature, 14. Phone and 15. Date
Enter 13. Commander's Signature, 14. Phone and 15. Date (YYYYMMDD).
16. Provider's Assessment
In 16. Provider's Assessment, either No enrollment in mandatory SUD treatment at this time.
In 16. Provider's Assessment, or Service member has an alcohol and/or other substance use disorder and is required to be enrolled in mandatory SUD treatment. Service member's first appointment is , Service member is required to participate in treatment IAW 635-200 or be subject to Administrative Separation for Chapter 9: Rehabilitation Failure.
Commanders are required to conduct rehabilitation testing in accordance with Service members' rehabilitation plan.
In 16. Provider's Assessment, or Other (specify).
17. Rehabilitation Team Meeting Date Completed
REHABILITATION TEAM MEETING (MANDATORY FOR MILITARY): Record of contact with command concerning this referral to include treatment plan and advising how to assist their Service member in treatment. Record face-to-face or telephone rehabilitation team meeting clinical notes within the DoD Electronic Health Record.
Enter 17. Rehabilitation Team Meeting Date Completed (YYYYMMDD).
Provider Office Phone, Government Email and Provider Signature
Office Phone:, Government Email: and Provider Signature:
More rules for DA Form 8003
PREVIOUS EDITIONS ARE OBSOLETE.
Sources
[1] DA Form 8003 (MAY 2018), Command Referral for a Substance Use Disorder (SUD) Evaluation, U.S. Army (the Official source link on this page).