Pdhra Dd Form 2900 – Fill Out and Use This PDF

The PDHRA DD Form 2900 serves as a crucial tool designed to evaluate the health of military personnel following their deployment. It aims to support healthcare providers in pinpointing both current and future medical needs, potentially leading to referrals for further healthcare, including behavioral health services. Highlighting its voluntary nature, the form stands as a bridge to ensuring the well-being of those who have served in military operations abroad.

For a comprehensive assessment of your post-deployment health status and to connect with the necessary healthcare services, consider completing the form. Click the button below to begin filling out your PDHRA DD Form 2900.

Get Form Now Download PDF

Pdhra Dd Form 2900 PDF Details

The Post-Deployment Health Reassessment (PDHRA) DD Form 2900 is a crucial document designed to evaluate the health status of military personnel after they return from deployment. Authorized under 10 U.S.C. 136, Chapter 55, 1074f, 3013, 5013, 8013, and Executive Order (E.O.) 9397, its primary mission is to facilitate a comprehensive assessment of a service member's physical and mental health. This form plays a pivotal role in identifying any immediate and future medical care needs, potentially leading to referrals for additional healthcare services, including behavioral health support. By collecting detailed information about the individual’s deployment experience, current health concerns, and interactions with healthcare providers post-deployment, the PDHRA aims to address a broad spectrum of health issues ranging from physical injuries to mental health symptoms. Disclosure of personal health information through the form is voluntary but critical for ensuring that service members receive the appropriate care and support. Additionally, the information may be shared with other Federal and State agencies as well as civilian healthcare providers as necessary, to facilitate proper medical care and treatment, highlighting the form’s importance in the seamless transition of care from military to civilian health services.

Question	Answer
Form Name	Pdhra Dd Form 2900
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	dd2900 post deployment health reassessment, O08, OEF, yyyy

Form Preview Example

POST-DEPLOYMENT HEALTH REASSESSMENT (PDHRA)

33348

Authority: 10 U.S.C. 136 Chapter 55. 1074f, 3013, 5013, 8013 and E.O. 9397

Principal Purpose: To assess your state of health after deployment in support of military operations and to assist military healthcare providers, including behavioral health providers, in identifying present and future medical care needs you may have. The information you provide may result in a referral for additional healthcare that may include behavioral healthcare.

Routine Use: To other Federal and State agencies and civilian healthcare providers as necessary in order to provide necessary medical care and treatment. Responses may be used to guide possible referrals.

Disclosure: Disclosure is voluntary.

INSTRUCTIONS: Please read each question completely and carefully before making your selections. Provide a response for each question. If you do not understand a question, ask the administrator. Please respond based on your MOST RECENT DEPLOYMENT.

Demographics

Last Name				Today's Date (dd/mm/yyyy)
First Name			MI	DOB (dd/mm/yyyy)
Date arrived theater (mm/yyyy)			Date departed theater (mm/yyyy)	Social Security Number
Gender	Service Branch		Status Prior to Deployment		Pay Grade
Male		Air Force	Active Duty		E1	O01	W1
Female		Army	Selected Reserves - Reserve - Unit		E2	O02	W2
		Navy	Selected Reserves - Reserve - AGR		E3	O03	W3
Marital Status		Marine Corps	Selected Reserves - Reserve - IMA		E4	O04	W4
Marital Status		Coast Guard	Selected Reserves - National Guard - Unit		E5	O05	W5
Never Married		Coast Guard	Selected Reserves - National Guard - Unit		E5	O05	W5
Never Married		Other	Selected Reserves - National Guard - AGR		E6	O06
Married		Other	Selected Reserves - National Guard - AGR		E6	O06
Married			Ready Reserves - IRR		E7	O07	Other
Separated			Ready Reserves - IRR		E7	O07	Other
Separated			Ready Reserves - ING		E8	O08
Divorced			Ready Reserves - ING		E8	O08
Divorced			Civilian Government Employee		E9	O09
Widowed			Civilian Government Employee		E9	O09
Widowed			Other			O10
			Other			O10
Location of Operation			Since return from deployment I have:		Current Contact Information:
Iraq		South America	Maintained/returned to previous status		Phone:
Afghanistan		North America	Transitioned to Selected Reserves:		Cell:
Kuwait		Australia	Transitioned to Ready Reserves:		DSN:
Qatar		Europe	Retired from Military Service		Email:
Bosnia/Kosovo		On a ship	Separated from Military Service		Address:
SW Asia - other		Other:
Africa
Total Deployments in Past 5 Years:			Current Unit of Assignment		Point of Contact who can always reach you:
OIF	OEF	Other			Name:
1	1	1			Phone:
2	2	2	Current Assignment Location		Email:
3	3	3			Mailing Address:
4	4	4
5 or	5 or	5 or
more	more	more
						33348
DD FORM 2900, JUN 2005					ASD(HA) APPROVED

1. Overall, how would you rate your health during the PAST MONTH?

Excellent

Very Good

Good

Fair

Poor

2.Compared to before your most recent deployment, how would you rate your health in general now?

Much better now than before I deployed Somewhat better now than before I deployed About the same as before I deployed Somewhat worse now than before I deployed Much worse now than before I deployed

3.Since you returned from deployment, about how many times have you seen a healthcare provider for any reason, such as in sick call, emergency room, primary care, family doctor, or mental health provider?

No visits

1 visit

2-3 visits

4-5 visits

Over 6 visits

4.Since you returned from deployment, have you been hospitalized?

5.During your deployment, were you wounded, injured, assaulted or otherwise physically hurt?

If NO, skip to Question 6.

5a. IF YES, are you still having problems related to this wound, assault, or injury?

6.Other than wounds or injuries, do you currently have a health concern or condition that you feel is related to your deployment?

IF NO, skip to Question 7.

	Yes	No
	Yes	No
Yes	No	Unsure
Yes	No	Unsure

6a. IF YES, please mark the item(s) that best describe your deployment-related condition or concern:

Chronic cough	Redness of eyes with tearing
Runny nose	Dimming of vision, like the lights were going out
Fever	Chest pain or pressure
Weakness	Dizziness, fainting, light headedness
Headaches	Difficulty breathing
Swollen, stiff or painful joints	Diarrhea, vomiting, or frequent indigestion
Back pain	Problems sleeping or still feeling tired after sleeping
Muscle aches	Difficulty remembering
Numbness or tingling in hands or feet	Increased irritability
Skin diseases or rashes	Taking more risks such as driving faster
Ringing of the ears	Other:

7. Do you have any persistent major concerns regarding the health effects of something you believe	Yes	No
you may have been exposed to or encountered while deployed?

IF NO, skip to Question 8.

7a. IF YES, please mark the item(s) that best describe your concern:

DEET insect repellent applied to skin	Paints
Pesticide-treated uniforms	Radiation
Environmental pesticides (like area fogging)	Radar/microwaves
Flea or tick collars	Lasers
Pesticide strips	Loud noises
Smoke from oil fire	Excessive vibration
Smoke from burning trash or feces	Industrial pollution
Vehicle or truck exhaust fumes	Sand/dust
Tent heater smoke	Blast or motor vehicle accident
JP8 or other fuels	Depleted Uranium (if yes, explain)
Fog oils (smoke screen)

Solvents	Other:

33348

DD FORM 2900, JUN 2005

8. Since return from your deployment, have you had serious conflicts with your spouse,		Yes	No	Unsure
family members, close friends, or at work that continue to cause you worry or concern?		Yes	No	Unsure

9. Have you had any experience that was so frightening, horrible, or upsetting that, IN THE PAST MONTH, you ....
a. Have had any nightmares about it or thought about it when you did not want to			Yes	No
b. Tried hard not to think about it or went out of your way to avoid situations that remind you of it			Yes	No
c. Were constantly on guard, watchful, or easily startled			Yes	No
d. Felt numb or detached from others, activities, or your surroundings			Yes	No
10. a. In the PAST MONTH, did you use alcohol more than you meant to?			Yes	No
b. In the PAST MONTH, have you felt that you wanted to or needed to cut down on your drinking?			Yes	No
11. Over the PAST MONTH, have you been bothered by the following	Not	Few or	More than	Nearly
problems?	at all	several	half the	every
		days	days	day

a.Little interest or pleasure in doing things

b.Feeling down, depressed, or hopeless

12.If you checked off any problems or concerns on this questionnaire, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Not difficult at all

Somewhat difficult

Very difficult

13.Would you like to schedule a visit with a healthcare provider to further discuss your health concern(s)?

14.Are you currently interested in receiving information or assistance for a stress, emotional or alcohol concern?

15.Are you currently interested in receiving assistance for a family or relationship concern?

Extremely difficult

Yes No

16. Would you like to schedule a visit with a chaplain or a community support counselor?

Yes

33348

DD FORM 2900, JUN 2005

Health Care Provider Only

SERVICE MEMBER'S SOCIAL SECURITY #

DATE (dd/mm/yyyy)

Provider Review and Interview

Review symptoms and deployment concerns identified on form:

Confirmed screening results as reported

Screening results modified, amended, clarified during interview:

Ask behavioral risk questions.

a. Over the PAST MONTH, have you been bothered by thoughts that you would be better off dead

Yes

or of hurting yourself in some way?

IF YES, about how often have you been bothered by these	Very few days
thoughts?

b.Since return from your deployment, have you had thoughts or concerns that you might hurt or lose control with someone?

3.IF YES OR UNSURE to behavioral risk questions, conduct risk assessment.

More than half	Nearly every day
of the time
Yes	No	Unsure

a. Does member pose a current risk for harm to self or others?	No, not a	Yes, poses a	Unsure, referred
	current risk	current risk
b. Outcome of assessment	Immediate	Routine follow-	Referral not indicated
	referral	up referral

4. Record additional questions or concerns identified by patient during interview:

Assessment and Referral: After my interview with the service member and review of this form, there is a need for further evaluation and follow-up as indicated below. (More than one may be noted for patients with multiple concerns.)

5. Identified Concerns	Minor	Major
	Concern	Concern

Physical Symptom

Exposure Concern

Depression Symptoms

PTSD Symptoms

Anger/Aggression

Suicidal Ideation

Social/Family Conflict

Alcohol Use

Other:

None

Already Under Care

Yes	No

6. Referral Information

a. No referral made

b. Immediate/emergent care

c. Primary Care, Family Practice d. Specialty Care:

e. Behavioral Health in Primary Care f. Mental Health Specialty Care

g. Case Manager, Care Manager h. Substance Abuse Program

i.Health Promotion, Health Education

j.Other Healthcare Service

7.Comments:

8.Provider

a.Name (Last, First)

b.Signature and stamp:

k. Chaplain

l. Family Support, Community Service m. Military OneSource

n. Other:

ICD-9 Code for this visit: V70.5_6

Ancillary Staff/Administrative Section

9. Member was provided the following:

10. Referral made to the following healthcare or support system:

Health Education and Information

Health Care Benefits and Resources Information Appointment Assistance

Service member declined to complete form

Service member declined to complete interview/assessment Service member declined referral for services

Other:

Military Treatment Facility

Division/Line-Based Medical Resource

VA Medical Center or Community Clinic

Vet Center

TRICARE Provider

Contract Support:

Community Service:

Other:

None

33348

DD FORM 2900, JUN 2005	ASD(HA) APPROVED

How to Edit Pdhra Dd Form 2900 Online for Free

When working in the online PDF tool by FormsPal, you are able to fill out or edit W3 here and now. FormsPal professional team is relentlessly endeavoring to develop the tool and enable it to be even better for people with its cutting-edge functions. Bring your experience one step further with continually improving and exciting possibilities we offer! It merely requires a couple of basic steps:

Step 1: Just hit the "Get Form Button" above on this webpage to start up our pdf file editing tool. This way, you will find all that is needed to fill out your file.

Step 2: When you launch the tool, you will get the form prepared to be completed. Apart from filling in various blanks, you might also do several other actions with the file, specifically adding any words, editing the original textual content, adding illustrations or photos, putting your signature on the form, and much more.

It is straightforward to fill out the document following our helpful guide! Here is what you want to do:

1. To start off, once completing the W3, start with the part that has the next blanks:

2. Your next part is usually to complete these fields: Iraq Afghanistan Kuwait Qatar, Total Deployments in Past Years, Current Unit of Assignment, OIF or more, OEF or more, Other or more, Current Assignment Location, Point of Contact who can always, DD FORM JUN, and ASDHA APPROVED.

Total Deployments in Past Years, Current Assignment Location, and Current Unit of Assignment of yyyy

Regarding Total Deployments in Past Years and Current Assignment Location, ensure you don't make any mistakes in this section. The two of these could be the key fields in the PDF.

3. Through this step, examine Overall how would you rate your, Excellent, Very Good, Good, Fair, Poor, Compared to before your most, Much better now than before I, Since you returned from, visits, Over visits, No visits, visit, Since you returned from, and During your deployment were you. All of these need to be filled out with highest attention to detail.

4. Completing a IF YES please mark the items, Chronic cough Runny nose Fever, Redness of eyes with tearing, Do you have any persistent major, Yes, a IF YES please mark the items, DEET insect repellent applied to, and Paints Radiation Radarmicrowaves is essential in the fourth section - always spend some time and fill out each field!

5. Finally, the following final portion is what you will need to complete prior to submitting the document. The blank fields in question are the next: DEET insect repellent applied to, DD FORM JUN, Paints Radiation Radarmicrowaves, and Other.

yyyy conclusion process outlined (step 5)

Step 3: Right after you've looked over the details entered, click "Done" to conclude your form. Join FormsPal today and easily gain access to W3, all set for download. All adjustments made by you are kept , letting you change the file at a later time anytime. FormsPal guarantees safe form completion devoid of data recording or sharing. Feel comfortable knowing that your details are safe here!

Pdhra Dd Form 2900 – Fill Out and Use This PDF

Pdhra Dd Form 2900 PDF Details

Form Preview Example

How to Edit Pdhra Dd Form 2900 Online for Free

Pdhra Dd Form 2900 isn’t the one you’re looking for?

Related Documents