DD 2813 dental form: what it records and how to complete it

The DD 2813 dental form is the Department of Defense record of a dental examination. It carries the dental readiness classification that follows from that examination. Specifically, its full official title is the Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination. A licensed dentist completes and signs it, and the classification then decides whether a service member counts as dentally deployable.

The form itself is short. It carries a five-field identification block, a three-tier checkbox for the member’s condition class, one brief written note, and the dentist’s signature. Instead, comprehensive charting stays in the practice’s own record. This guide, in turn, covers each field, who needs an examination, and how the two TRICARE dental programs use the result.

The official form is published by the Department of Defense. Instead, the free file below is a general patient information template that dental practices can use alongside it.

Found our content helpful?

Key takeaways

DD 2813 is the Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination, completed and signed by a licensed dentist

The form records a three-tier condition class and one short written note, not a tooth-by-tooth clinical record

Dental readiness classification (DRC) categories 1 to 4 record oral health status and decide whether a service member is deployable

Examinations are documented under the TRICARE Active Duty Dental Program and the TRICARE Dental Program, both administered by United Concordia

The official form is published by the DoD Executive Services Directorate and downloaded from there

The free file on this page is a general patient information template, not a copy of the official form

The official DD Form 2813 is published by the DoD Executive Services Directorate and has to be downloaded from there. Use the template above to gather patient history before the appointment, then record the examination itself on the current DoD form.

What is the DD 2813 dental form?

The DD 2813 dental form is the official Department of Defense form for documenting dental examinations. Specifically, it covers Active Duty service members, Reserve Forces, National Guard personnel, and certain federal civilian employees. Its full title is the Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination.

The Executive Services Directorate manages the form under the Office of the Secretary of Defense. As a result, it is the authoritative record used to establish a dental readiness classification, and that classification feeds DoD readiness reporting.

Without a current, correctly completed DD 2813 on file, a service member can be classified as non-deployable. In turn, that has immediate operational consequences for the unit. Accurate medical form documentation therefore carries operational weight in a practice that treats military patients.

What the free template on this page covers

The downloadable file is a general clinical intake form that any dental practice can hand to a patient before an examination. In particular, it is not a facsimile of DD Form 2813, and it does not reproduce that form’s layout or its readiness fields. It collects the following:

• Patient and record details: name, date of birth, date completed, record or MRN number, address, phone, and email.
• Emergency contact: the contact’s name, relationship to the patient, and phone number.
• Reason for completing the form: free text, plus a check on whether the patient has completed the form before.
• Relevant history: free text for background history, current medication, supplements, and allergies.
• Patient declarations: confirmation that the information is accurate, a promise to report changes, and acknowledgment of the privacy notice.
• Office use only: received by, date received, action taken, reference number, and a signature and date line.

What it leaves out matters just as much. There is no condition class or readiness field, no DEERS identifier, and no branch or unit entry. It carries no examining-dentist license block either. Those fields sit only on the DoD form, so the readiness decision belongs there.

If you want a chairside record for the examination itself, use our dental examination form alongside this one. It gives you somewhere to write the findings that the DoD form deliberately leaves out.

How to complete the DD 2813 dental form

First, the examination follows five stages, from patient identification through to the dentist’s signature. The sequence below reflects the field order described on the official TRICARE ADDP forms page and in the ESD source document. Always work from the current version of the form.

1. Record patient identification data. Complete the top section with the member’s name, Social Security or DoD ID number, branch of service, unit of assignment, and unit address. In turn, these five fields tie the examination to the member’s record in the Defense Enrollment Eligibility Reporting System (DEERS). Errors here stop the record matching in readiness databases.
2. Check the condition class. The examination section is a three-tier checkbox rather than a charting grid. Class 1 means no treatment or re-examination is expected for 12 months. Class 2 covers conditions unlikely to cause an emergency in that window. Class 3 covers conditions likely to cause one. That checkbox is the readiness decision.
3. Write the brief condition note. A class 3 entry needs a short written description of the condition behind it. The form allows one line, so name the site and the problem plainly. Keep the charting and the full findings in your structured patient records.
4. Enter the examination and x-ray dates. Record the date of the examination and the date of any radiographs taken. These dates set the 12-month clock that decides when the member is due again.
5. Sign and submit. The examining dentist signs and dates the form, then prints their name, title, license number, and phone number. Practices that run digital patient intake can keep a timestamped copy in the patient record for audit and retrieval.

The brevity is deliberate. DD Form 2813 disclaims any role as a comprehensive dental record, so it asks for a classification and a signature rather than a clinical narrative. Tooth-by-tooth charting, periodontal status, restorations, caries, the treatment plan, and any specialist referral all stay in your own chart.

That split is where documentation errors start. The panel below sets the form’s fields against the ones your practice keeps.

Who the form applies to

The form reaches well beyond military dental facilities. Knowing which personnel categories need one prevents missed examinations and incorrect claim submissions.

• Active duty military dentists and contracted civilian dentists treat service members under the TRICARE Active Duty Dental Program (ADDP). They use the form for every periodic dental examination.
• Reserve and National Guard dentists examine personnel during annual training, mobilization physicals, and pre-deployment health assessments. Accordingly, they use the DD 2813 to establish or update readiness status.
• Private dental practices near military installations treat TRICARE-enrolled patients too. They meet the form when they examine members covered by the TRICARE Dental Program (TDP), administered by United Concordia Companies Inc (UCCI).
• Dental hygienists and clinical staff prepare documentation before the dentist’s review. Knowing the field sequence lets them gather the right data during the initial assessment.
• Likewise, practice managers overseeing compliance and records retention need to know the submission timelines and retention obligations for completed forms.

Benefits of a structured dental examination record

Working from a structured, pre-formatted record rather than ad hoc notes reduces errors and shortens the write-up. It also protects the practice during a TRICARE audit or DoD review.

• Standardized field sequencing stops clinicians skipping required sections. Every examination captures the same data points, which makes records comparable across visits and practitioners.
• Class consistency improves when the readiness fields carry clear prompts. Inconsistent classifications usually trace back to loose documentation rather than clinical disagreement.
• Audit readiness starts with the first entry. TRICARE and DoD reviews expect specific fields in specific formats, so structured records keep submissions from failing on technicalities.
• Faster claim submission follows complete documentation. When every field is populated at the point of examination, billing staff can submit the claim the same day.

How dental readiness classification works

Dental readiness classification is the core output of every DD 2813 examination. The DoD uses DRC categories to judge whether a service member’s oral health permits deployment. Four categories apply, though only the first three appear on the form. DRC 4 is applied administratively when no current examination is on record.

DRC 3 is the most operationally significant category. The form gives you one line to describe the condition behind it, so name the site and the problem. A class 3 box checked with no written description is a common reason a submitted form gets queried.

TRICARE programs behind the examination

In practice, two TRICARE dental programs sit behind these examinations, and their eligibility rules differ. Confusing them is one of the most common documentation errors in practices that treat both military and civilian patients.

• TRICARE Active Duty Dental Program (ADDP) covers active duty service members and is administered by UCCI through the addp-ucci.com portal. Care is provided at no cost to the member, at military treatment facilities or through ADDP network providers. The DD 2813 documents the examination outcome and the readiness classification.
• TRICARE Dental Program (TDP) is a premium-based program, also administered by UCCI. It covers Selected Reserve and Individual Ready Reserve members, plus the families of active duty, Guard, and Reserve members. Retired service members and their families are not eligible for TDP. They enroll in FEDVIP dental instead.

Practices that see both populations should keep separate workflow triggers for each program. ADDP examinations follow DoD-mandated intervals and are reported centrally. TDP examinations are driven by benefit eligibility and member-initiated access. In short, keeping each program’s records current stops readiness data and claims from crossing over.

Submission and record retention

A completed form has a defined submission pathway and a retention obligation. Practices that treat these steps as informal tend to run into claim delays and readiness reporting problems.

• Submission: completed forms go to the member’s unit dental officer or the military treatment facility records section. ADDP network providers submit electronically through the UCCI provider portal. Keep a timestamped copy in your own record system first.
• Retention: DoD guidance requires dental examination records to be kept for a defined period after the member separates. Apply your standard medical records retention policy as a minimum, which is typically six to ten years depending on state law.
• Version control: always use the current ESD-published version. The version is printed in the document footer, so an older version can invalidate the submission.

Data protection duties apply to military dental records exactly as they do to civilian ones. HIPAA obligations follow DoD-connected records held by civilian providers. Compliance management tools inside your practice software reduce the risk of an accidental disclosure during transfer and submission.

How Pabau supports military dental documentation

A single DD 2813 appointment produces four outputs: a compliance record, a readiness classification, a treatment plan, and a TRICARE claim. Practices that handle those on paper re-key the same patient details four times. They then chase the dentist for the entries nobody filled in.

Pabau keeps all four under one patient file. The intake form, the examination notes, the condition class, and the claim sit together with audit timestamps. Staff can pull a full record in seconds when TRICARE queries a submission.

Pabau Scribe, our AI scribe, structures the clinical note during the examination itself. Findings reach the record while the dentist is still with the patient. The documentation cycle then runs from patient identification to submission confirmation without a printed page leaving the practice.

Keep military patient records complete and audit-ready

Pabau brings digital intake forms, structured patient records, and documentation workflows into one system for dental practices serving military patients. Every examination record stays complete, timestamped, and easy to retrieve.

Book a demo

Conclusion

The DD 2813 dental form decides whether a service member is cleared for deployment, and it does that with a single checkbox. Complete it on the current DoD version, justify a class 3 with a written note, and keep a timestamped copy before you submit.

Treat the form as the summary it is, and keep the clinical detail somewhere you can retrieve it. A practice that splits those two records well answers a TRICARE query in minutes rather than days. To see how Pabau handles military dental documentation, book a demo with our team.

Continue your research

Clearing a patient before surgery or deployment? Dental clearance form covers the sign-off a referring provider needs before treatment goes ahead.

Onboarding a new military family? Dental new patient form collects the contact, insurance, and consent details you need before the first appointment.

Need a fuller history than intake captures? Dental medical history forms template walks through the conditions, medication, and allergies that change treatment planning.

Comparing systems for clinical records? Clinical documentation software explains what to look for when examination notes have to survive an audit.

Frequently asked questions