The first sections are allergies, health conditions, medications, supplements, hospitalizations, surgeries and counseling.
Family history: Service Members Only.
Screening exams: N = Normal, AB = Abnormal, NA = Not Indicated per USPSTF or Service Policy.
Immunizations: enter date for each dose as ddmmyyyy. Where applicable enter titer date and Medical Immune exemption as “MI -ddmmyyyy”.
Disclosure: voluntary.
Failure to provide: the information requested may result in delays in assessing dental health needs for military service and/or for possible deployment.
| Question | Answer |
|---|---|
| Form Name | DD Form 2766 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 744 |
| Avg. time to fill out | 60+ min |
| Edition | AUG 2023 |
| Privacy Act | This form is subject to the Privacy Act of 1974 |
| Other names | DD Form 2766, DD 2766, DD2766, Total Force Health Readiness Flowsheet |
| Official source | DD Form 2766 (Rev AUG 2023), Department of Defense |
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