Get U.s. Dod Form Dod-da-4465

This guide provides comprehensive instructions on how to fill out the U.S. DOD Form Dod-da-4465 online. This form is vital for documenting patient intake and screening records, facilitating essential services for personnel within the Department of Defense.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to retrieve the form and open it in your online editor.
2. Fill in your date of enrollment/screening in the format YYYYMMDD. Ensure this date reflects when you started the screening process.
3. Enter the patient identification details, including your date of birth in YYYYMMDD format and the service area code.
4. Select your department by checking the appropriate box: Army, Air Force, Navy, Marine, Coast Guard, Public Health Service, DOD Agency, or Other.
5. Choose your eligibility category by selecting one of the provided options relevant to your status.
6. Indicate whether you consent to release information to your supervisor by checking the appropriate box.
7. Fill in the case finding method by selecting either biochemical or non-biochemical methods.
8. For military personnel or civilian employees, fill out your component and grade.
9. Select your patient position and complete the mandatory testing position if applicable.
10. In the section designated for physician use, enter the primary diagnosis and code, and make sure to have the physician sign and provide their name and grade.
11. In the enrollment decision section, select whether to enroll or not and provide reasons accordingly.
12. Complete the signature sections for both the counselor and clinical director to finalize the document.
13. Once you have filled out all sections, save your changes. You may also choose to download, print, or share the completed form as needed.

Complete your U.S. DOD Form Dod-da-4465 online today to ensure timely processing of your records.