DD Form 2813. Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination

DD Form 2813, also referred to as the "Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination," is a vital document used within the Department of Defense. This form, with the Nov 2021 revision, falls under the Controlled Unclassified Information (CUI) category known as PRVCY and is managed by the Defense Health Agency (DHA).

Key Information:

• Previous Edition Obsolete: All prior versions of this form are no longer valid.
• CUI when filled: Contains sensitive, but unclassified information.
• LDC: FEDCON - Federal Control Number.
• Point of Contact (POC): For inquiries, contact [email protected].
• OMB Approval Number: OMB No. 0720-0022.
• OMB Approval Expiry: The OMB approval is valid until 20230131, expiring on January 31, 2023.

Purpose: This form serves the critical purpose of collecting essential patient information required to assess an individual's readiness for participation in a military deployment.

Authorities and Legal Basis: Several legal provisions and authorities guide the use of this form. These include Public Law 104-191 (Health Insurance Portability and Accountability Act of 1996), various sections of Title 10 of the United States Code (U.S.C.), as well as other relevant regulations and executive orders.

Routine Uses: Information within this form may be disclosed to different entities within the Department of Defense to assess readiness for military deployment. It may also be shared with private physicians and various federal agencies, including the Departments of Veterans Affairs, Health and Human Services, and Homeland Security. This sharing is done to ensure the patient's medical care, eligibility for benefits, and compliance with public health laws. Furthermore, it may be shared with government and non-government third parties for the recovery of healthcare costs provided by the Military Health System.

Applicable SORN (System of Records Notice): The form aligns with EDHA 07, "Military Health Information System," a relevant SORN which was last updated on June 15, 2020.

Disclosure and Voluntariness: Filling out this form is voluntary, but it's crucial for the assessment of the individual's dental health, military service needs, and potential deployment. Failing to provide the requested information may result in delays in evaluating dental health and deployment readiness.

Form Components: This form includes the following sections:

1. Service Member's Information: Collects details like name, DoD ID number, branch of service, unit of assignment, and unit address.
2. Examination Results: Dentists are instructed to assess the dental health of the individual and mark the appropriate condition that best describes the patient's dental health. It emphasizes fitness for prolonged duty without immediate access to dental care rather than comprehensive dental needs.
3. Additional Details on Condition: If Block (3) is selected to indicate dental conditions expected to result in emergencies, the dentist must specify the identified conditions.
4. X-Ray Consultation: Dentists need to specify whether X-rays were consulted and provide the date of the X-ray if applicable.
5. Dentist's Information: The dentist's name, telephone number, signature, license number, and the date of the examination.

Conclusion: DD Form 2813 plays a critical role in the Department of Defense, ensuring that individuals within its forces maintain good dental health and are ready for deployment. Once completed, the form is submitted to the member's military unit and becomes part of their official military personnel file, where it serves as an essential reference for readiness and health status within the Department of Defense.