Dd form 2813 dental 2021 pdf-2025

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The document is a Department of Defense form for the Active Duty/Reserve Forces Dental Examination, which assesses a service member's dental health to determine their fitness for prolonged duty without immediate access to dental care. It includes sections for personal information, examination results, and dentist details, emphasizing the importance of evaluating oral health conditions that may lead to emergencies within the next 12 months.

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Click ‘Get Form’ to open the dd form 2813 dental 2021 pdf in the editor.
Begin by entering the service member's name in the designated field at the top of the form. Ensure you include their last name, first name, and middle initial.
Next, input the social security number in the appropriate section. This is crucial for identification purposes.
Select the branch of service from the provided options. This helps categorize your submission correctly.
Fill in the unit of assignment and address fields accurately to ensure proper routing of your examination results.
In the examination results section, mark (X) the block that best describes the patient's dental health condition based on your assessment.
If applicable, circle any specific conditions identified during your examination or provide a brief description in the space provided.
Complete dentist information including name, address, telephone number, and signature along with state license number before submitting.

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What is a DD form 2813?

Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination Form (DD Form 2813) This form is used to used to assist active duty and National Guard and Reserve members in documenting dental health for worldwide duty. It should be downloaded and given to the dental provider to complete.

How to get a dental waiver for the military?

If a civilian dental exam is accomplished when a military exam is not required, it must be documented on a DD Form 2813, Department of Defense Active Duty/Reserve Forces Dental Examination, and submitted to the servicing dental clinic.

What is the dental code D0190?

The code D0190 procedure occurs where a person meets with a licensed or duly authorized health care professional in order to determine whether there are any evident clinical dental conditions that should be further investigated by a dentist.

What is the Tricare dental program?

You can request a waiver online using the BreEZe system at .BreEZe.ca.gov. Select the waiver application in the drop-down menu under the Manage your License Information section and attach a copy of your military orders when prompted. You can also request a waiver by sending a message to the Board.

What is the dental code D9944?

Dental clearance is communication between a healthcare provider and a patients dentist to validate that planned medical/surgical treatment is safe for the patient and to review the potential need for dental treatment before the medical/surgical treatment.

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What is the dental form for QTC?

Dental Exam (Annual) for Reserve Component Soldiers To schedule your annual dental exams, follow the instructions for the PHA and schedule through LHI. You can also have your personal dentist complete the Dental Examination Form (DD Form 2813) and submit to QTC through for the dental record update.