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This version of the form is not currently in use and is provided for reference only. Download this version of
DA Form 3822
for the current year.
DA Form 3822 Report of Mental Status Evaluation
What Is DA Form 3822?
DA Form 3822, Report of Mental Status Evaluation , is a form used to document the results of a service member's behavioral health evaluation. The latest version of the form - often incorrectly referred to as the DD Form 3822 - was released by the U.S. Department of the Army (DA) on March 1, 2017 . An up-to-date DA Form 3822 fillable version can be downloaded below.
Alternate Name:
- Army Mental Status Evaluation Form.
DA Form 3822 is a document that incorporates key components required for proper diagnosis of the service member's behavioral health. It is used by Army behavioral health providers as a part of the clinical assessment process in psychiatric practice to receive a clear cross-sectional description of a service member's mental status. This document provides the behavioral service provider with a convenient and structured means to observe, analyze, evaluate, and document the patient's mental state through cognition, perception, behavior, attitude, judgment, insight, and other indications.
The DA 3822 is the only valid form that can be used by behavioral health providers within a Military Treatment Facility to document a behavioral or mental health status of a service member. It is the only document that complies with mandatory school evaluation requirements, administrative separation requirements, and command-directed evaluations. No alternative forms are authorized.
DA Form 3822 Instructions
The Army policies and guidelines for use of the DA 3822 are provided in Army Regulation 40-66, Medical Record Administration and Healthcare Documentation. The form is used for:
- Advanced school evaluation;
- Mental status evaluation when a service member applies for a position of significant trust and authority;
- Administrative separation evaluation;
- Misconduct administrative separation evaluation;
- Service member's behavioral health evaluation requested by a commander.
The commander may request a mental health evaluation if the service member's words or actions arise suspect of causing injury to themselves or to others, facts and circumstances show the possibility of such injury, or the commanding officer believes the subordinates are possibly suffering from a severe mental disorder . The evaluation instructions are simple:
- Determining the need for evaluation, the commander locates the closest Military Treatment Facility that has specialists capable to perform behavioral health evaluation.
- The commander finds out the requirements of the facility (e.g., if an escort is needed) and arranges the meeting between the service member in question and a behavioral health provider.
- The commander notifies the service member about evaluation and explains the reasons via a memo in compliance with the Department of Defense Instruction 6490.4, Requirements for Mental Health Evaluations of Members of the Armed Forces. No developmental counseling form is used in this case.
- The commander must comprehensively explain that the aim of the evaluation is to obtain the information, not to provide treatment. The commander furnishes behavioral health providers with all the relevant information particularly focusing on the issue that arose the concern.
- After visiting the appointed meeting, the service member returns with the filled-out DA Form 3822.
- The commander examines the information provided via the form and decides how to proceed with the situation.
- The commander may request help from the Director of Psychological Health.
The provided instructions and requirements are included in the Army Reserve Psychological Health Program. The main aim of this program is to help Army leaders and units to make an informed decision regarding each case and to provide aid to service members who experience behavioral health issues.
How to Fill Out DA Form 3822?
The person responsible for conducting the Army Mental Status Evaluation is a behavioral health provider. The document consists of seven sections, and must include:
- The service member's identification information.
- The service member's diagnosis.
- Fitness for duty determination.
- Information about medications and treatment, if any.
- Recommendations and explanations for the commander.
- Signature of the behavioral health provider who performed the evaluation.
Download DA Form 3822 Report of Mental Status Evaluation
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