DENTIST S TELEPHONE NUMBER Include Area Code 10. DENTIST S SIGNATURE/STATE LICENSE NUMBER DD FORM 2813 OCT 2013 PREVIOUS EDITION IS OBSOLETE. 11. DEPARTMENT OF DEFENSE ACTIVE DUTY/RESERVE/GUARD/CIVILIAN FORCES DENTAL EXAMINATION OMB No* 0720-0022 OMB approval expires Aug 31 2016 The public reporting burden for this collection of information is estimated to average 3 minutes per response including the time for reviewing instructions searching existing data sources gathering and maintaining the...
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Laws calm legal forms guide a DD Form 2813 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 2813 is available on the Department of Defense documentation website or can be supplied through the chain of command to begin filling out the DD Form 2813 you must bring the form with you to a dental professional who can give you an examination provide your personal information in boxes 1 through 5 provide your name social security number branch of service unit and unit address the rest of the form needs to be filled out by a dentist in box 6 the dentist must rate the candidates dental condition with either a good dental rating some oral conditions which won't result in a dental emergency within 12 months or oral conditions which will result in a dental emergency within 12 months if the dentist determines that a dental emergency will arise within 12 months he or she must indicate what dental conditions exist the dentist should further describe the dental conditions if any are present that would cause a dental emergency within 12 months if x-rays were conducted on the applicant the dentist must indicate the date they were taken the dentist will then provide their name and contact information in boxes 7 through 11 once the dentist signs off on the DD Form 2813 the form is ready for submission to the Department of Defense at the address provided on the top of the form to watch more videos please make sure to visit laws calm