DD Form 2813 PDF Details

The DD Form 2813, also known as the Department of Defense Reserve Forces Dental Examination form, serves a crucial role in assessing the dental health and readiness of members of the United States Armed Forces Reserve components for duty. This form, approved by the OMB with an expiration date of December 31, 2002, is designed to ensure that service members can perform prolonged duty worldwide without immediate access to dental care. It requires a detailed examination by a dentist, who will evaluate the service member's oral health using a clinical examination with a mirror and probe and bite-wing radiographs, among other methods. The assessment's outcomes are pivotal in determining the member's fitness for duty by identifying various oral conditions and their potential to cause dental emergencies within the next 12 months. Conditions identified can range from infections, caries/restorations, missing teeth, periodontal conditions, oral surgery needs, to temporomandibular disorders, thereby guiding necessary interventions to prevent dental emergencies while on duty. Furthermore, the DD Form 2813 underscores the importance of maintaining comprehensive oral health records for military personnel, aligning with the Department of Defense's commitment to the overall well-being of its members. By highlighting the form's purpose, process, and significance, the comprehensive evaluation it facilitates not only aids in the preventive health measures for military personnel but also reinforces the operational readiness of the United States Armed Forces Reserve Components.

QuestionAnswer
Form NameDD Form 2813
Form Length1 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out27 sec
Other namesdd form 2813 printable march 2017, dd form 2813 dental fillable, da form 2813 fillable, da 2813

Form Preview Example

DEPARTM ENT OF DEFENSE

RESERVE FORCES DENTAL EXAM INATION

Form Approved

OMB No. 0720 -0022

Expires Dec 31, 2002

The public report ing burden f or t his collect ion of inf ormat ion is est imat ed t o average 3 minut es per response, including t he t ime f or review ing inst ruct ions, searching exist ing dat a sources, gat hering and maint aining t he dat a needed, and complet ing and review ing t he collect ion of inf ormat ion. Send comment s regarding t his burden est imat e or any ot her aspect of t his collect ion of inf ormat ion, including suggest ions f or reducing t he burden, t o Depart ment of Def ense, Washingt on Headquart ers Services, Direct orat e f or Inf ormat ion Operat ions and Report s (0720-0022), 1215 Jef f erson Davis Highw ay, Suit e 1204, Arlingt on, VA 22202-4302. Respondent s should be aw are t hat not w it hst anding any ot her provision of law , no person shall be subject t o any penalt y f or f ailing t o comply w it h a collect ion of inf ormat ion if it does not display a current ly valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.

PRIVACY ACT STATEM ENT

AUTHORITY: Public Law 105 -85, Sec. 765; DoD Direct ive

ROUTINE USE(S): None.

6490 .2; E.O. 9397 .

 

PRINCIPAL PURPOSE(S): An assessment by a dent ist of t he

DISCLOSURE: Volunt ary; how ever, f ailure t o provide t he

inf ormat ion may result in delays in assessing your dent al

st at e of your dent al healt h f or t he next 12 mont hs is needed

healt h needs f or milit ary service.

t o det ermine your f it ness f or prolonged dut y w it hout ready

 

access t o dent al care.

 

 

1 . SERVICE M EM BER' S NAM E (Last , First , Middle Init ial)

2 . SOCIAL SECURITY NUM BER

3 . BRANCH OF SERVICE

4 . UNIT OF ASSIGNM ENT

5 . UNIT ADDRESS

6 . EXAM INATION RESULTS Dear Doct or,

The individual you are examining is a Guard/Reserve member of t he Unit ed St at es Armed Forces. This member needs your assessment of his/her dent al healt h f or w orldw ide dut y. Please mark (X) the block t hat best describes t he condit ion of t he member, using as a suggest ed minimum a clinical examinat ion w it h mirror and probe, and bit e w ing radiographs. This form is meant to determine fitness for prolonged duty w ithout ready access to dental care and is not intended to address the member' s comprehensive dental needs.

(1)Pat ient has good oral healt h and is not expect ed t o require dent al t reat ment or reevaluat ion f or 12 mont hs.

(2)Pat ient has some oral condit ions, but you do not expect t hese condit ions t o result in dent al emergencies w it hin 12 mont hs if not t reat ed (i.e., requires prophylaxis, asympt omat ic caries w it h minimal ext ension int o dent in, edent ulous areas not requiring immediat e prost het ic t reat ment ).

(3)Pat ient has oral condit ions t hat you do expect t o result in dent al emergencies w it hin 12 mont hs if not t reat ed. Examples of such condit ions are: (X t he applicable block or specif y in t he space provided)

(a)Infections: Acut e oral inf ect ions, pulpal or periapical pat hology, chronic oral inf ect ions, or ot her pat hologic lesions and lesions requiring biopsy or aw ait ing biopsy report .

(b)Caries/Restorations: Dent al caries or f ract ures w it h moderat e or advanced ext ension int o dent in; def ect ive rest orat ions or t emporary rest orat ions t hat pat ient s cannot maint ain f or 12 mont hs.

(c)M issing Teeth: Edent ulous areas requiring immediat e prost hodont ic t reat ment f or adequat e mast icat ion, communicat ion, or accept able est het ics.

(d)Periodontal Conditions: Acut e gingivit is or pericoronit is, act ive moderat e t o advanced periodont it is, periodont al abscess, progressive mucogingival condit ion, moderat e t o heavy subgingival calculus, or periodont al manif est at ions of syst emic disease or hormonal dist urbances.

(e) Oral Surgery: Unerupt ed, part ially erupt ed, or malposed t eet h w it h hist orical, clinical, or radiographic signs or sympt oms of pat hosis t hat are recommended f or removal.

(f ) Other: Temporomandibular disorders or myof ascial pain dysf unct ion requiring act ive t reat ment .

(4)If you select ed Block (3) above, please circle t he condit ion(s) you ident if ied in t his pat ient if t hey appear above, or brief ly describe t he condit ion(s) below :

(5) Were X-rays consult ed?

 

YES

 

NO

IF YES, DATE X -RAY WAS TAKEN (YYYYMMDD)

 

 

 

 

 

 

 

 

 

7 . DENTIST' S NAM E (Last , First , Middle Init ial)

 

8 . DENTIST' S ADDRESS (Include ZIP Code)

 

 

 

9 . DENTIST' S TELEPHONE NUM BER (Include Area Code)

 

 

 

 

 

 

 

 

1 0 . DENTIST' S SIGNATURE

1 1 . DATE OF EXAM INATION (YYYYMMDD)

DD FORM 2 8 1 3 , DEC 1 9 9 9

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Ways to prepare dental form dd part 1

2. When the previous part is complete, you have to insert the required details in b CariesRestorations Dental caries, c M issing Teeth Edentulous areas, d Periodontal Conditions Acute, e Oral Surgery Unerupted partially, f Other Temporomandibular, If you selected Block above, Were Xrays consulted, YES, IF YES DATE XRAY WAS TAKEN YYYYMMDD, DENTIST S NAM E Last First Middle, DENTIST S ADDRESS Include ZIP Code, DENTIST S TELEPHONE NUM BER, DENTIST S SIGNATURE, and DATE OF EXAM INATION YYYYMMDD so you're able to progress further.

Stage number 2 of filling in dental form dd

3. The next part is rather simple, DENTIST S SIGNATURE, DATE OF EXAM INATION YYYYMMDD, and DD FORM DEC - every one of these empty fields must be completed here.

dental form dd conclusion process outlined (step 3)

In terms of DATE OF EXAM INATION YYYYMMDD and DD FORM DEC, ensure that you don't make any mistakes in this current part. Those two are the key ones in this PDF.

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