Department dd form 28 department of defense active dutyreserve forces dental examination form approved omb no. 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. The dd 28 dental form is filled out both by the soldier receiving the dental examination and by the dentist providing it you must bring the form with you to the examination and hand it to your doctor. Dd form 28071 oct 2018 page 2 of 3 pages last name, first name, middle name suffix social security number b. To download a document, rightclick on the link and select save target as. Dd form 28, active dutyreserve forces dental examination, october 20 author. The active duty dental program privacy act statement.
Your dentist has to sign the form after the dental tests are over. For a low monthly fee, you gain access to a number of highend features that are available through the bigger companies. Nervous trouble of any sort anxiety or panic attacks e. Download fillable dd form 1907 in pdf the latest version applicable for 2020. Dd form 28 download fillable pdf or fill online department. A fillable copy of the dd form 28 can be downloaded below or can be supplied through the chain of command. 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.
Select initial, updated, or after action report and enter the date. Fill out the signature and tally record online and print it out for free. This form must be completed entirely and submitted to united concordia before an appeal can be processed. Sign, fax and printable from pc, ipad, tablet or mobile. Preventing transmission of diseases through food by infected employees with. Dd form 28 printable fill out and sign printable pdf template. The soldier is given a dental readiness class based on the results of the dd 28 dental form. Unerupted, partially erupted, or malposed teeth with historical, clinical, or radiographic signs. Dd form 25002999 executive services directorate washington. Dd form 28 active duty reserve forces dental examination.
Links to important forms for the active duty dental program. Dd form 28 oct 20 fillable forged petechial that commissuretime. Dd form 28 guard reserve dental readiness classification. Dd form 1907 download fillable pdf or fill online signature. 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. Class i is given to soldiers with perfect oral hygiene who are not expected to require dental treatment or reevaluation for the next 12 months. Pdf, data for payment of retired personnel dd form 26565. Army da administrative publications and forms by the army publishing directorate apd. Dd form 28 e pubs 3m for the first few considerations king x reader lemon forced needs. 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 2971, conditional employee or food employee reporting.
You must submit this form and receive an appointment control number acn from united concordia before receiving private sector dental care. Dd2620, request for laboratory determination of rabies, 8120, no, army. Directives division washington headquarters services. Dd form 28 download fillable pdf or fill online department of.
Learn how to fill the dd 1750 form packing list duration. Dutyreserve guardcivilian forces dental examination form dd form 28. This form should be completed by the dtf or civilian provider and will be used to assist the services in documenting member dental health. This form is meant to determine fitness for prolonged duty without ready access to care and is not intended to. Download it as a pdf or print a copy for your reference. If the form number does not have a hyperlink, the form is not available electronically. Da 28 fill online, printable, fillable, blank pdffiller. Pdf, application for identification carddeers enrollment dd form 2656.
This statement serves to inform you of the purpose for collecting personal information required by the addp claim form and how it will be used. Dd form 28, active dutyreserve forces dental examination. Dd form 28, active dutyreserve forces dental examination the government requires all active. The form is used by military physicians to determine if an applicant is fit for extended service away from dental help. The form must be completed entirely and submitted to united concordia before an appeal can be processed. This collection of information, including suggestions for reducing the burden, to the department of defense, washington. This form is for active duty service members in remote locations who do not need authorization to receive private sector dental care. Dd28, department of defense active dutyreserveguardcivilian forces dental examination, 312017, no. A claim denial can be appealed by completing the appeals form. Department of defense, army forms, business, united states federal legal forms and united states legal forms. The examination form often incorrectly referred to as the da form 28 was revised by the department of defense dod in march 20. 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. Dd28 dental form omb no 07200022 omb approval expires.
Dd form 28071 report of medical history legal forms. Army publishing directorate army publishing directorate. A dd form 28071 is a department of defense form is used for gathering medical information for applicants to military service. Loss of memory or amnesia, or neurological symptoms 17. Pdf, reserve component survivor benefit plan rcsbp election certificate. Fill now fillable online dd form 28 october 20 vq6fj. The dd form 28, dod active dutyreserve forces dental examination, will be used to. Active dutyreserve forces dental examination the government requires all active duty and reserve members receive an annual dental examination. Dd28 department of defense active duty reserve forces dental examination pdf dd28 department of defense active duty reserve forces dental examination wednesday, april. The latest technologies high quality electronic pubs and forms view u. 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. Dd28 department of defense active duty reserve forces dental examination pdf dd28 department of defense active duty reserve forces dental examination wednesday, april 15, 2020. Fill dd form 28 oct 20 dtic instantly, edit online. The form is used by military physicians to determine if an applicant can be accepted or should be disqualified on medical grounds.
Download fillable dd form 28 in pdf the latest version applicable for 2020. If the specific date cannot be determined, enter an. To obtain hard copies of current forms not available in electronic format, please contact your own military service or dod component forms management officer. Forces dental examination a dd form 28 is a department of defense form is used for gathering dental information for military.
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