Get the free da4187 for orthodontic form

CONFIDENTIAL Date: MEDICAL DENTAL HISTORY FORM FOR ADULTS Patient's Last Name: First Name: M.I.: Birth Date: Age: Sex: Male Female Prefers to be called: SSN # Home Phone No: () Cell Phone No: () —

How to fill out da4187 for orthodontic form

How to fill out da4187 for orthodontic form:

1. Begin by accessing the da4187 form. You can obtain it from your unit’s administrative office or download it from the official Army website.
2. Fill in your personal information, such as your name, rank, social security number, and contact information.
3. Indicate the date on which you are filling out the form.
4. Specify the type of dental treatment you are seeking, which in this case would be orthodontic treatment.
5. Provide details about the specific orthodontic procedure you require, such as braces or Invisalign.
6. Include the justification for the orthodontic treatment. This could involve explaining any dental issues or functional impairments that orthodontic treatment will help correct.
7. If applicable, attach any supporting documentation, such as dental records or letters from your dentist or orthodontist.
8. Sign and date the form.
9. Submit the completed da4187 form to the appropriate personnel or administrative office for processing.

Who needs da4187 for orthodontic form:

1. Active-duty military personnel who require orthodontic treatment can utilize the da4187 form.
2. Reservists or National Guard members may also need to fill out this form if they are eligible for dental services as part of their military benefits.
3. Dependents of service members, including spouses and children, who are eligible for dental care through the military may need to complete the da4187 form for orthodontic treatment as well.

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What is da4187 for orthodontic form?

DA Form 4187 is the Personnel Action form used by the U.S. Army. However, there is no specific DA Form 4187 for orthodontic purposes.

Who is required to file da4187 for orthodontic form?

There is no specific DA Form 4187 for orthodontic purposes, so no one is required to file it.

How to fill out da4187 for orthodontic form?

There is no specific DA Form 4187 for orthodontic purposes, so there are no specific instructions on how to fill it out.

What is the purpose of da4187 for orthodontic form?

There is no specific DA Form 4187 for orthodontic purposes, so there is no specific purpose for it.

What information must be reported on da4187 for orthodontic form?

There is no specific DA Form 4187 for orthodontic purposes, so no information needs to be reported on it.