DA Form 8003. Command Referral for a Substance Use Disorder (SUD) Evaluation

DA Form 8003 is an official document used by the United States Department of Defense (DoD) in accordance with AR 40-66 regulations. The purpose of this form is to facilitate a command referral for a comprehensive Substance Use Disorder (SUD) assessment of a service member. The assessment aims to determine if the individual meets the criteria for mandatory enrollment in a Substance Use Disorder (SUD) treatment program.

Key Information Captured on DA Form 8003:

1. Personal Information: This form begins by capturing essential personal details of the service member, including their name, rank/grade, Department of Defense (DOD) ID, date of birth (YYYYMMDD), unit, and other relevant information.

2. Deployment and Flight Status: It inquires about the service member's deployment status, whether they are expected to depart the installation within 90 days, and whether they are on flying status or involved in the Personnel Reliability Program.

3. Reason for Referral: The form specifies the reason for the referral, which can be due to a positive urine analysis (UA) result, a drug/alcohol-related incident (with details), or other factors requiring evaluation.

4. Record of Legal and Disciplinary History: The form prompts the recording of any civilian arrests, convictions, courts-martial, company punishments, and disciplinary problems, including pending issues, with specific dates and offenses.

5. Performance and Behavioral Assessment: The service member's performance and behavioral conduct are assessed, including their efficiency and conduct in the categories of excellent, good, fair, or unsatisfactory.

6. Commander's Signature: The commanding officer signs and provides their contact phone number and the date of the referral, affirming the referral's accuracy.

7. Provider's Assessment: This section is completed by the provider conducting the SUD evaluation. It indicates whether the service member is required to be enrolled in mandatory SUD treatment, the date of the first appointment, and the required treatment plan. It mentions that commanders are obliged to conduct rehabilitation testing in accordance with the rehabilitation plan.

8. Rehabilitation Team Meeting: For military personnel, the form captures the date of the rehabilitation team meeting, which is mandatory.

9. Provider Contact Information: It provides the contact information of the referring provider, including the office phone number and government email.

Usage Scenario: DA Form 8003 is used in military settings when a service member is referred by their command for a comprehensive evaluation of a suspected Substance Use Disorder (SUD). The form helps initiate the assessment process, record key details, and facilitates communication between the referring command and the behavioral health or medical personnel responsible for the evaluation.

Privacy Note: The information provided on DA Form 8003 is considered for official use only and is protected under the Privacy Act of 1974. Unauthorized disclosure of this information is prohibited.