Member Forms / DD FORM 2900
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Complete all identification fields. Provide your 10-digit DoD ID number located on the back of your CAC. To be completed electronically — handwritten forms will not be accepted.
Component & duty status
Confirm your component (Active Duty, National Guard, Reserves, or Civilian Government Employee). Reserve and Guard members complete the additional items — availability, Line of Duty, and TRICARE Reserve Select drive eligibility and periodicity.
⚠ Reserve Component member — PHA/readiness periodicity follows the drill cycle; complete the Line of Duty and TRICARE Reserve Select items.
Contact information
Current contact information and a point of contact who can always reach you.
Most recent deployment
Please answer all questions below based on your most recent deployment.
Self-reported health (Questions 1–7)
Please answer all questions based on your most recent deployment.
8. Symptoms during the PAST MONTH
During the PAST MONTH, how much have you been bothered by any of the following problems? (Not bothered at all · Bothered a little · Bothered a lot)
Stressors, mental health, medications & alcohol (Questions 9–12)
13. Traumatic stress screening (PCL)
Have you ever had any experience that was so frightening, horrible, or upsetting that, in the PAST MONTH, you:
14. Depression screening (PHQ)
Over the LAST 2 WEEKS, how often have you been bothered by the following problems? If 14a. or 14b. are marked “More than half the days” or “Nearly every day,” continue to answer items 14c. through 14i.
Environmental exposures & animal contact (Questions 15–17)
Requests for assistance (Questions 18–21)
⚑ Positive behavioral-health screen — a Mental Health Assessment is indicated.Complete DD 2978 →
Health Care Provider — Information
HEALTH CARE PROVIDER ONLY. Complete provider identification below.
Provider Review, Interview, Assessment & Recommendations (Blocks 1–4)
Deployer reports most recent deployment was to ____ and has deployed ____ times before in the past five years.
Provider Assessment — Symptoms, Stressors & Screenings (Blocks 5–10)
Provider Assessment — Exposure, Rabies, Suicide & Violence Risk (Blocks 11–14)
Provider Assessment & Referral (Blocks 15–20)
After review of deployer's responses and interview with the deployer, the assessment and need for further evaluation is indicated in blocks 16 through 19.
Provider certification
This visit is coded by DOD0213.
I hereby certify that this review process has been completed.
Attest
Member attestation: the reassessment responses above are accurate.