Links to important forms for the active duty dental program. This letter prescribes the use of a new form dd form 28 department of defense reserve forces dental examination. Please mark x the block that best describes the condition of the member, using as a suggested minimum a clinical examination with mirror and probe, and bitewing radiographs. Of defense active dutyreserveguardcivilian forces dental examination online. Active dutyreserve forces dental examination form approved omb no. The department of defense dod forms management program is administered by the directives division dd, executive services directorate, washington headquarters services. Forces dental examination a dd form 28 is a department of defense form is used for gathering dental information for military. Dd form 28 active dutyreserve forces dental examination the government requires all active duty and reserve members receive an annual dental examination. If dental examination not done by dental officer, explain in item 44. Fill dd form 28 oct 20 dtic instantly, edit online. Form 28 was revised by the department of defense dod in march 20. T h i s p u b l i c a t i o n i s a m a j o r revision. If youre in the tricare dental program, network dentists can complete the dental exam form for you at no cost. Dutyreserve guardcivilian forces dental examination form dd form 28.
The active duty dental program privacy act statement. Dd form 28 printable fill out and sign printable pdf template. This form is meant to determine fitness for prolonged duty without ready access to dental care and is not intended to address the members comprehensive dental needs. Dd form 28, active dutyreserve forces dental examination. This form should be completed by the dtf or civilian provider and will be used to assist the services in. Oct 19, 2016 dd form 28, active dutyreserve forces dental examination dd form 28, sep 2006. Dd form 28 e pubs 3m for the first few considerations king x reader lemon forced needs. Having trouble downloading pdf files or with the pdf editor.
Download free printable army dental examination form samples in pdf, word and excel formats. Dd form 28 download fillable pdf or fill online department of. It is the soldiers responsibility to ensure that the form is sent to the proper place. Laws calm legal forms guide a dd form 28 is a department of defense form used for gathering dental information for military members who will spend an extended period of time away from dental services the form is used by military physicians to determine if an applicant is fit for extended service away from dental help the dd form 28 is available on the department of defense documentation. To obtain hard copies of current forms not available in electronic format, please contact your own military service or dod component forms management officer. For a low monthly fee, you gain access to a number of highend features that are available through the bigger companies. When revisions to these publications are published, those revisions will aspersed this letter. Dd form 25002999 executive services directorate washington. The dd form 28, dod active dutyreserve forces dental examination, will be used to assist the tdpenrolled national guardreserve forces in documenting. If the form number does not have a hyperlink, the form is not available electronically. Pdf, reserve component survivor benefit plan rcsbp election certificate. All books are in clear copy here, and all files are secure so dont worry about it. Dd form 28, active dutyreserve forces dental examination the government. The information in this letter will be incorporated into ar 4035 and ar4066.
Preventive care helps minimize more advanced dental services that can be costly, timely and affect dental readiness. Medical services preventive dentistry and dental readiness army regulation 4035 effective 21 august 2016 h i s t o r y. Army dental examination form 1 free templates in pdf. Dd form 28 guard reserve dental readiness classification the dd form 28, dod active dutyreserve forces dental examination, will be used to assist the tdpenrolled national guardreserve forces in documenting member dental health. The examination form often incorrectly referred to as the da form 28 was revised by the department of defense dod in march 20. Service members may use civilian dentist and a dd 28 to meet annual dental requirement 2 out of 3 years. Pdf, data for payment of retired personnel dd form 26565. Active duty dental program appointment of appeal representative active duty service members in remote locations may appeal click to close the action you take if you dont agree with a decision made about your benefit. A004066b dasg, health care and medical treatment record system.
This letter prescribes the use of a new form, dd form 28 department of defense reserve forces dental examination. Print out the form and take it to your nonarmy dental provider. Health protection to preventive dentistry and dental readiness cover. Thats why there are forms such as physical examination forms and medical examination forms. Active dutyreserve forces dental examination the government requires all active duty and reserve members receive an annual dental examination. Public health service\ngeneral instructions for completing medical examination forms dd28071 report of medical history and dd2808 report of medical examination. Jun 28, 2019 dental readiness you must complete an annual dental exam if youre a member of the national guard and reserve. But even they need to make sure that theyre keeping up with their hygiene, which is why there are dental examination forms.
The form is used by military physicians to determine if an applicant is fit for extended service away from dental help. Medical services preventive dentistry and dental readiness army regulation 4035 effective 21 august 2016. A dd form 28 is a department of defense form is used for gathering dental information for military members who will spend an extended period of time away from dental services. Dd form 28 applies to members of the examinations performed by civilian dentists. Department dd form 28 department of defense active dutyreserve forces dental examination form approved omb no. This form should be completed by the dtf or civilian provider and will be used to assist the services in documenting member dental health.
You should also have a dental examination form dd 28 completed within 1 year of this form, if not, complete one instructions on first page. To collect information necessary for completion of your dental readiness examination conducted by a dental provider and to collect information necessary for the dental provider to submit a claim for payment for the dental services provided to you. Hqda ltr 40012 expires 2 july 2003 see distribution 1. Download fillable dd form 28 in pdf the latest version applicable for. Directives division washington headquarters services. Dd form 28 fill online, printable, fillable, blank. Da 28 fill online, printable, fillable, blank pdffiller.
If youre in the tricare dental program, network dentists can complete the dental exam form for you at no cost you will have to. Dd form 28 documents dental examinations provided by the service members civilian dentist. Dd forms 20002499 washington headquarters services. Sign, fax and printable from pc, ipad, tablet or mobile. At least once every 3 years, a military dental officer must provide the annual dental exam per reference b. Dd28 dental form omb no 07200022 omb approval expires. Educational materials military dental forms please note. T h i s r e g u l a t i o n d e f i n e s t h e army dental readiness and oral health protection programs. The drc must be entered into ddsw for either the military or civilian annual examination. Learn how to fill the dd 1750 form packing list duration. The directives division administers and operates the dod issuances program, the dod information collections program, dod forms management program, gao affairs, and the dod plain language program for the office of the secretary of defense. Dd form 28 guard reserve dental readiness classification the dd form 28, dod active dutyreserve forces dental examination, will be used to assist the tdpenrolled national guardreserve forces in documenting member dental. You are here home legal forms department of defense dd forms dd28 department of defense active dutyreserve forces dental examination form categories citizenship and immigration services uscis.
Dd form 28, active dutyreserve forces dental examination dd form 28, sep 2006. Dd28, department of defense active dutyreserve guardcivilian forces dental examination, 312017, no, dha dd2815, alternative. All establishments need to make sure that their employees are in tiptop shape. Department of defense active dutyreserve forces dental. A fillable copy of the dd form 28 can be downloaded below or can be supplied through the chain of command. Only the claim form should be used to submit claims. Tdp dentists are familiar with documenting dental health by completing the dd form 28 for national guard or reserve members. Print content only for preprinted forms 12321 type. Form rct128c report of change in corporate net income tax. Page 2 of form dd 2808 name and serno at top of page must be completed. Dd form 28 active duty reserve forces dental examination.
Dd form 28 download fillable pdf or fill online department. Dtf manual, this manual is an addp reference guide for dtf staff. Fill, sign and download army dental examination form online on. Fillable and printable army dental examination form 2020. Medical services preventive dentistry and dental readiness. Dec 22, 2019 a dd form 28 is a department of defense form is used for gathering dental information for military members who will spend an extended period of time away from dental services. You may only be examined by a civilian provider two times. Fill out, securely sign, print or email your dd form 28 oct 20 instantly with. Dod forms management washington headquarters services. Department of defense active dutyreserve forces dental examination form approved omb no.
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