DD Form 2766 at a glance
What it is: DD Form 2766 is the Total Force Health Readiness Flowsheet.
Where and when to file: INDIVIDUAL’S IDENTIFICATION has RECORDS MAINTAINED AT.
The form collects patient information necessary to determine the patient's readiness to participate in a military deployment. Disclosure is 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.
A filled-in DD Form 2766 example: a soldier fills out page 1
How to fill out DD Form 2766, box by box
1. Allergies
1. ALLERGIES has a. MEDICATION ALLERGIES and b. OTHER ALLERGIES.
2. Health conditions
2. HEALTH CONDITIONS has a. DEPLOYMENT LIMITING HEALTH CONDITIONS and b. OTHER HEALTH CONDITIONS/MEDICAL EQUIPMENT REQUIREMENTS.
3. Medications, 4. Supplements, 5. Hospitalizations and 6. Surgeries
The form lists 3. MEDICATIONS, 4. SUPPLEMENTS, 5. HOSPITALIZATIONS and 6. SURGERIES.
7. Counseling
7. COUNSELING has a DATE for SAFE SEX/FAMILY PLANNING, for CONTRACEPTIVE COUSELING (Pre-Deployment), for TRAVEL, for SICKLE CELL TRAIT (SCT) and for OTHER, and a LIVING WILL/DATE FILED: line.
8. Occupational history/risk
8. OCCUPATIONAL HISTORY/RISK has a. PRP YES NO, b. AUOF YES NO, c. FLYING STATUS YES NO, d. DIVE/SUBMARINER YES NO and e. OTHER: YES NO If other, specify.
Individual's identification
In INDIVIDUAL’S IDENTIFICATION, use the space for the mechanical imprint and fill in RECORDS MAINTAINED AT. Under INDIVIDUAL'S NAME enter LAST, FIRST and M.I., mark MALE or FEMALE under SEX, and fill in STATUS, RANK/GRADE, DEPT/SERVICE, ORGANIZATION, DoD EIN/SSN and DATE OF BIRTH.
9. Family history
FAMILY HISTORY is for Service Members Only. M = Mother, F = Father, S = Sibling, MGM = Maternal Grandmother, MGF = Maternal Grandfather, PGM = Paternal Grandmother, PGF = Paternal Grandfather. It has a. CANCER (Specify), b. CARDIOVASCULAR DISEASE (Specify), c. DIABETES (Specify), d. MENTAL ILLNESS/CHEMICAL DEPENDENCY (Specify) and e. OTHER (Specify).
10. Screening exams
SCREENING EXAMS: N = Normal, AB = Abnormal, NA = Not Indicated per USPSTF or Service Policy. They are (1) WEIGHT, (2) HEIGHT, (3) BLOOD PRESSURE, (4) CHOLESTEROL, (5) ASCVD RISK SCORE, (6) HEARING, (7) ORAL/DENTAL, (8) EYE/VISION, (9) PAP SMEAR, (10) and (11).
11. Immunizations
IMMUNIZATIONS: enter the date for each dose as ddmmyyyy. Where applicable enter titer date and Medical Immune exemption as “MI -ddmmyyyy”. In section 11, enter type of immunization above date in split boxes for lines e, g, l, o.
The lines are a. Hep A / Titer, b. Hep B / Titer, c. Twinrix, d. MMR / Titer, e. Varicella / Titer, f. Td or Tdap, g. Polio, h. Influenza (NH or SH), i. COVID-19, j. Yellow Fever, k. Meningococcal ACWY, l. Japanese Encephalitis, m. Typhoid (Vivotif or Typhim VI), n. Rabies, o. Anthrax, p. Smallpox (ACAM or Jynneos), q. Other and r. Other.
For s. PPD or IGRA, enter mm or result and date.
More rules for DD Form 2766
12. READINESS has a. DNA/DATE, b. BLOOD TYPE/DATE/RESULT, c. RH / DATE / RESULT:, d. SICKLE CELL SCREEN/ DATE/RESULT:, e. G6PD (Glucose-6-phosphate dehydrogenase) DATE QUALITY QUANTITY, f. PHA (DD3024) DATE (1) DATE (2) DATE (3) DATE (4) DATE (5) DATE (6), g. DENTAL EXAM, h. PERMANENT PROFILE CHANGE/WAIVER?, DEPLOYMENT WAIVERS:, i. GLASSES/GASMASK Rx:, j. HEARING AIDS/ BATTERIES, k. HEARING PROTECTION DEVICE (HPD) and l. HIV Test.
13. DEPLOYMENT HEALTH (DH) has a. LOCATION CCMD and b. LOCATION COUNTRY.
DH REQUIREMENTS COMPLETED has a DATE (1) to DATE (6) for (1) RECORD REVIEW, (2) PRE-DHA (DD2795), (3) WALKING BLOOD BANK, (4) ANAM, (5) PRE-DEPLOYMENT SERUM, (6) MHA IN THEATER (DD2978), (7) PDHA (DD2796), (8) MHA REDEPLOYMENT (DD2978), (9) POST-DEPLOYMENT SERUM, (10) SHPE/SHA (if required), (11) PDHRA (DD2900), (12) DMHA4 (DD2978/3024) and (13) DMHA5 (DD2978/3024).
d. FORCE HEALTH PROTECTION RX has ITEM, DOSE, QUANTITY ISSUED and ISSUE DATE.
The continuation sheet has OTHER (Test, Exam, etc.), FREQ, DATE and RESULTS/NOTES, and REMARKS.
Sources
[1] DD Form 2766 (AUG 2023), Total Force Health Readiness Flowsheet, Washington Headquarters Services (the Official source link on this page).