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This page contains forms used for documenting deployment-related health evaluations and evaluations of specific deployment-related conditions. It also contains standard health assessment tools that can be used for evaluating patients with deployment-related concerns and links to related web sites.
Government Forms for Documenting Deployment-Related Health Evaluations DD Form 2844, Post Deployment Medical Assessment, Mar 02 (Test Form)
Optional form, used in place of SF 600, for documenting evaluations of deployment-related medical conditions/concerns as part of the Post-Deployment Heatlh Clinical Practice Guideline (PDH-CPG)
DD Form 2697, Report of Medical Assessment,
Feb 95
Form used to document a comprehensive medical assessment for active duty and reserve component service members separating or retiring
from active duty.
DD Form 2795, Pre-Deployment Health Assessment, May 99
Required form for assessing state of health prior to deployment and determining
medical deployability. A PDF version of the form is provided here as a preview of the questions that are included on the form. The form must be
completed in an electronic or web-enabled form following service-specific directives and using one of the following service-specific data systems:
Army MEDPROS (Medical Protection System);
Air Force PIMR (Preventive Health Assessment and
Individual Medical Readiness) or AFCITA (Air Force Complete Immunization Tracking System) for AFRC; or Navy
EDHA (Electronic Deployment Health Assessment).
DD Form 2796, Post-Deployment Health Assessment, Jan 08
Required form for documenting health at time of return from deployment and any deployment-related occupational / environmental exposures. The April
2003 version of the form was updated in September 2007 to enhance questions on behavioral health and add questions on traumatic brain injury. A PDF
version of the form is provided here as a preview of the questions that are included on the form. The form must be completed in an electronic
or web-enabled form following service-specific directives and using the following service-specific data systems:
Army MEDPROS (Medical Protection System); Air Force
PIMR (Preventive Health Assessment and
Individual Medical Readiness) or AFCITA (Air Force Complete Immunization Tracking System) for AFRC; or Navy
EDHA (Electronic Deployment Health Assessment).
Information on how to complete the form is in each military service's PDHA implementation policy.
Links to the service-specific sites where the Deployment Health Assessment forms can be completed are:
DD Form 2808, Report of Medical Examination, Oct 05
Form used to document medical data for determination of medical fitness for enlistment, induction, appointment and retention for applicants and members of the Armed Forces. The information is also used for medical boards and separation of Service members from the Armed Forces (DoD exception to SF 88 approved by ICMR, August 3, 2000.)
DD Form 2900, Post-Deployment Health Reassessment, Jan 08
Required form used during the Post-Deployment Health Reassessment
(PDHRA) Process for documenting deployment-related health concerns during the three- to six-months after return from deployment. A PDF version of the form
is provided here as a preview of the questions that are included on the form. The form must be completed in an electronic or web-enabled form
following service-specific directives and using one of the following service-specific data systems: Army MEDPROS (Medical Protection System); Air Force PIMR (Preventive Health Assessment and Individual Medical Readiness) or AFCITA (Air Force Complete Immunization Tracking System) for AFRC; or Navy EDHA (Electronic Deployment Health Assessment). Servicemembers will be contacted by their unit leaders and given information on how to access the electronic or web-enabled version when they fall within the timeframe for completing the PDHRA process. The June 2005 version of the form was updated in September 2007 to enhance questions on behavioral health and add questions on traumatic brain injury. Information on how to complete the form is in each military service's PDHRA implementation policy.
Links to the service-specific sites where the Deployment Health Assessment forms can be completed are:
DA Form 2173, Statement of Medical Examination and Duty Status, Oct 02
Form used to document line of duty determination.
Standard Health Assessment Tools
Post Deployment Clinical Assessment Tool (PDCAT), 20 May 03
Form consisting of an array of brief standardized
illness-specific screens and assessments which can be used in its entirety to assess and follow-up patients with post-deployment health
concerns and illnesses. Many of the illness-specific sections can be used individually to follow severity of specific illnesses. Measures
patient status in the following areas: somatic symptoms; PTSD; depression; anxiety and panic; functional status; alcohol use; frequency of
healthcare visits; social support; and satisfaction with healthcare.
Patient Health QuestionnaireTM
Generic questionnaire used to screen and monitor patient status in the areas of: depression, anxiety, alcohol abuse and idiopathic physical symptoms. The PHQ-Brief has 8 questions and the PHQ has 16 questions.
Post Traumatic Stress Disorder (PTSD) Checklist (PCL)
Self-administered quesionnaire with 17 questions for assessing trauma-related stress. Three different versions are available.
RESPECT-MIL Forms and Measures
- Forms and measures used in the implementation of the RESPECT-Mil (Re-Engineering Systems for the Primary Care Treatment of Depression and PTSD in the Military) Program.
Specific Deployment-Related Conditions Forms and Measures Depleted Uranium
Related Links DoD/Joint Forces
Army
Air Force
Navy/Marines
Coast Guard
National Guard Bureau
Veterans Administration
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