MENTAL STATUS EVALUATION REQUEST DATE SSN NAME RANK MOS TYPE OF EVALUATION REQUESTED Mental Status Evaluation for Chapter Proceedings Chapter 5-13 Personality Disorder Chapter 14-12b Pattern of Misconduct Chapter 5-17 Other Mental Condition Chapter 14-12c Serious Offense Other Drill SGT School Ranger School Special Response Team Training Recruiter School Sniper School Other Command Directed Mental Health Evaluation Commander must obtain date tim.
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How to fill out the Meddac Form 514 online
Filling out the Meddac Form 514 is an essential step in initiating a mental status evaluation request. This guide will provide you with detailed, step-by-step instructions on how to accurately complete the form online, ensuring a smooth submission process.
Follow the steps to successfully complete the Meddac Form 514.
- Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Enter the date in the designated field at the top of the form.
- Input the social security number (SSN) in the specified section to identify the service member.
- Fill in the name of the service member, ensuring clarity in presentation.
- Enter the rank and military occupational specialty (MOS) of the service member in their respective fields.
- Select the type of evaluation being requested. You may choose from options such as a mental status evaluation for Chapter proceedings or command-directed mental health evaluation by marking the appropriate box.
- If applicable, provide details for other types of evaluations requested. Mention specific courses or duties, ensuring to complete this section as needed.
- Include the date, time, and location of the appointment with the mental health provider as instructed, with guidance from the commander.
- Detail the reason or behavior prompting the evaluation request, as forms submitted without an explanation will be returned.
- Review the service member rights section, which details important information regarding the evaluation.
- Ensure the service member signs the form to acknowledge their understanding of the rights listed.
- Obtain and include the printed name, rank, and phone number of the commander, followed by their signature.
- Once all fields are completed, save changes to the document. You can download, print, or share the form as required.
Complete the Meddac Form 514 online to ensure your evaluation request is processed promptly.
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