Advanced Search Home

Forms and Measures Page

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, Sep 12
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, Sep 12
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, Sep 12  
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.

Back to topBack to Top

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)
The PCL is a self-administered questionnaire for assessing trauma-related stress. It has been updated recently to correspond to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The previous PCL for DSM-4 had three versions, PCL-M (military), PCL-C (civilian), and PCL-S (specific), which varied slightly in the instructions and wording of the phrase referring to the index event. PCL-5 is most similar to the PCL-S (Specific Version). There are no corresponding PCL-M or PCL-C versions of PCL-5.

Short-Form 36 Health Survey (SF-36)
Multipurpose health survey that measures overall health status, functional status, and health-related quality of life. It is a generic measure and its use is not restricted to a single disease state. It can be used to monitor specific and general populations to estimate disease burden and after deployment, it can be used to quantify the severity of an individual's post-deployment health issue at any point in time as well as allowing comparisons of his or her health status over time.

Back to topBack to Top

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.

Back to topBack to Top

Specific Deployment-Related Conditions Forms and Measures

Depleted Uranium

Back to topBack to Top

Related Links

DoD/Joint Forces
Army
Air Force
Navy/Marines
Coast Guard
National Guard Bureau
Veterans Administration

Back to topBack to Top

  Click here to download of a free version of the Acrobat Reader plug-in to view PDF documents.

External Links Disclaimer
 Browser Information Security & Privacy Notice 


www.PDHealth.mil is the Official Web site of the DoD Deployment Health Clinical Center
Located at Walter Reed National Military Medical Center, Bethesda, MD (MRMC)