FORM_TYPE |
META |
Type of Form |
PRE |
ADMIN |
Exact Match (all same field name)
|
FORM_VERSION |
META |
DoD Form Version |
DD2795_202012 |
ADMIN |
Exact Match (all same field name)
|
LNAME |
DEM |
Last Name |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
FNAME |
DEM |
First Name |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
MI |
DEM |
Middle Initial |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
DODID |
DEM |
DoD ID number (formerly EDIPI) |
9999999999 |
IDENTITY |
Primary Join Key
|
D_EVENT |
DEM |
Today's Date (date on form) |
YYYYMMDD |
DEPLOYMENT |
Semantic Match – All 3 Schemas
|
DOB |
DEM |
Date of Birth |
YYYYMMDD |
DEMOGRAPHICS |
Exact Match (all same field name)
|
SEX |
DEM |
Sex |
M=Male, F=Female |
DEMOGRAPHICS |
Semantic Match – All 3 Schemas
|
FORM_SERVICE |
DEM |
Service Branch |
F=Air Force, A=Army, N=Navy, M=Marine Corps, S=Spa |
DEPLOYMENT |
Semantic Match – All 3 Schemas
|
SERVICE_OTHER |
DEM |
Other Defense Agency |
Text Field |
DEPLOYMENT |
Exact Match (all same field name)
|
FORM_COMPONENT |
DEM |
Component |
A=Active Duty, N=National Guard, R=Reserves, X=Civ |
DEPLOYMENT |
Exact Match (all same field name)
|
GRADE |
DEM |
Pay Grade |
E01=E1, E02=E2, E03=E3, E04=E4, E05=E5, E06=E6, E0 |
DEMOGRAPHICS |
Semantic Match – All 3 Schemas
|
GRADE_OTHER |
DEM |
Other Grade |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
UNIT_NAME |
DEM |
Unit Name |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
UNIT_LOC |
DEM |
Duty Station/Location |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
PHONE |
DEM |
Current Phone |
Text Field |
DEMOGRAPHICS |
Semantic Match – All 3 Schemas
|
CELL |
DEM |
Current Cell Phone |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
DSN |
DEM |
Current DSN |
Text Field |
OTHER |
Exact Match (all same field name)
|
EMAIL |
DEM |
Current Email |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
ADDR |
DEM |
Current Address |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
CITY |
DEM |
Current CITY |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
STATE |
DEM |
Current STATE |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
ZIP |
DEM |
Current ZIP Code |
Text Field |
DEMOGRAPHICS |
Exact Match (all same field name)
|
POC_NAME |
DEM |
POC Name |
Text Field |
OTHER |
Exact Match (all same field name)
|
POC_PHONE |
DEM |
POC Phone |
Text Field |
OTHER |
Exact Match (all same field name)
|
POC_EMAIL |
DEM |
POC Email |
Text Field |
OTHER |
Exact Match (all same field name)
|
POC_ADDR |
DEM |
POC Address |
Text Field |
OTHER |
Exact Match (all same field name)
|
POC_CITY |
DEM |
POC CITY |
Text Field |
OTHER |
Exact Match (all same field name)
|
POC_STATE |
DEM |
POC STATE |
Text Field |
OTHER |
Exact Match (all same field name)
|
POC_ZIP |
DEM |
POC ZIP Code |
Text Field |
OTHER |
Exact Match (all same field name)
|
D_DEPLOY |
DEM |
Estimated Date of deployment |
YYYYMMDD |
DEPLOYMENT |
Unique to DD2795
|
COUNTRY |
DEM |
Country |
Text Field |
DEPLOYMENT |
Semantic Match – DD2795 & DD2796
|
OPERATION_NAME |
DEM |
Name of Operation |
Text Field |
DEPLOYMENT |
Semantic Match – All 3 Schemas
|
DEPLOY_PREV |
DEM |
Previous deployments |
0=None, 1=1, 2=2, 3=3, 4=4, 5=5 or more, blank=not |
DEPLOYMENT |
Unique to DD2795
|
DEP_PRIMARY |
DEM |
Primary country of last deployment |
Text Field |
OTHER |
Unique to DD2795
|
D_RET_PREV |
DEM |
Date of Return from previous deployment |
YYYYMMDD |
OTHER |
Unique to DD2795
|
HEALTH_ASSESSMENT |
1 |
Overall, how would you rate your health during the PAST MONTH? |
E=Excellent, V=Very Good, G=Good, F=Fair, P=Poor |
OTHER |
Exact Match (all same field name)
|
LIGHT_DUTY |
2 |
Are you CURRENTLY on a profile, limited duty, waiting on a MOS/Medical Retention |
Y=Yes, N=No, U=Don't know |
PHYSICAL_SYMPTOMS |
Unique to DD2795
|
LIGHT_DUTY_REASON |
2 |
Reason for light duty |
Text Field |
PHYSICAL_SYMPTOMS |
Unique to DD2795
|
TOBACCO |
3 |
How often do you smoke tobacco |
0=Not at all, 1=some days, 2=just about every day |
OTHER |
Unique to DD2795
|
PREGNANT |
4 |
Are you pregnant or is there a chance |
1=Currently or may be pregnant, 2=pregnant within |
OTHER |
Unique to DD2795
|
CONTRA_COUNSEL |
5 |
Do you wish to receive contraceptive counseling? |
Y=Yes, N=No, blank=missing |
OTHER |
Unique to DD2795
|
CARE_HEAD |
6 |
In the past year did you receive care for a head injury? |
Y=Yes, N=No, blank=missing |
OTHER |
Unique to DD2795
|
CARE_HEAD_TEXT |
6 |
Please Explain (head) |
Text Field |
OTHER |
Unique to DD2795
|
CURRENT_MEDS |
7 |
What prescription or over-the- counter medications (including herbals/supplement |
0=None, 1=Yes response (Medications) |
OTHER |
Exact Match (all same field name)
|
CURRENT_MEDS_TEXT |
7 |
If yes, please list. |
Text Field |
OTHER |
Exact Match (all same field name)
|
CARE_MENTAL |
8 |
In the PAST YEAR did you receive care for any mental health condition or concer |
Y=Yes, N=No, blank=missing |
OTHER |
Exact Match (all same field name)
|
CARE_MENTAL_TEXT |
8 |
If yes, please explain |
Text Field |
OTHER |
Exact Match (all same field name)
|
NOISES |
9a |
Noises in your head or ears (such as ringing, buzzing, crickets, humming, tone, |
0=Not bothered at all, 1=Bothered a little, 2=Both |
EXPOSURE_ENVIRONMENT |
Unique to DD2795
|
HEARING |
9b |
Trouble hearing Past month |
0=Not bothered at all, 1=Bothered a little, 2=Both |
PHYSICAL_SYMPTOMS |
Unique to DD2795
|
ETOH_OFTEN |
10a |
How often do you have a drink containing alcohol? |
0=Never, 1=Monthly, 2=2-4 times a month, 3=2-3 tim |
SUBSTANCE_USE |
Exact Match (all same field name)
|
ETOH_DAY |
10b |
How many drinks containing alcohol do you have on a typical day when you are dri |
1=1 or 2, 2=3 or 4, 3=5 or 6, 4=7 to 9, 5=10 or mo |
SUBSTANCE_USE |
Exact Match (all same field name)
|
ETOH_BINGE |
10c |
How often do you have six or more drinks on one occasion? |
0=never, 1=Less than monthly, 2=monthly, 3=weekly, |
SUBSTANCE_USE |
Exact Match (all same field name)
|
NIGHTMARES |
11a |
Have you ever had any experience that was so frightening, horrible, or upsetting |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
AVOID_SITUATIONS |
11b |
Have you ever had any experience that was so frightening, horrible, or upsetting |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
ON_GUARD |
11c |
Have you ever had any experience that was so frightening, horrible, or upsetting |
Y=Yes, N=No, blank=missing |
OTHER |
Exact Match (all same field name)
|
DETACHED |
11d |
Have you ever had any experience that was so frightening, horrible, or upsetting |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
BLAME |
11e |
Felt guilt or unable to stop blaming yourself or others for the event(s) or any |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
MEMORIES |
11f |
Have you been bothered by that problem in the PAST MONTH. Repeated, disturbing m |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
DREAMS |
11g |
Have you been bothered by that problem in the PAST MONTH. Repeated, disturbing d |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
RELIVING |
11h |
Have you been bothered by that problem in the PAST MONTH. Suddenly acting or fee |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
UPSET |
11i |
Have you been bothered by that problem in the PAST MONTH. Feeling very upset whe |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
PHYS_REACTION |
11j |
Have you been bothered by that problem in the PAST MONTH. Having physical reacti |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
AVOID_THINK |
11k |
Have you been bothered by that problem in the PAST MONTH. Avoid thinking about o |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
AVOID_ACTIVITIES |
11l |
Have you been bothered by that problem in the PAST MONTH. Avoid activities or si |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
TROUBLE_MEMORY |
11m |
Have you been bothered by that problem in the PAST MONTH. Trouble remembering im |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
DISINTEREST |
11n |
Have you been bothered by that problem in the PAST MONTH. Loss of interest in th |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
DISTANT |
11o |
Have you been bothered by that problem in the PAST MONTH. Feeling distant or cut |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
NUMB |
11p |
Have you been bothered by that problem in the PAST MONTH. Feeling emotionally nu |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
DOOM |
11q |
Have you been bothered by that problem in the PAST MONTH. Feeling as if your fut |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
INSOMNIA |
11r |
Have you been bothered by that problem in the PAST MONTH. Trouble falling or sta |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
ANGRY_OUTBURSTS |
11s |
Have you been bothered by that problem in the PAST MONTH. Feeling irritable or h |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
CONCENTRATE |
11t |
Have you been bothered by that problem in the PAST MONTH. Having difficulty conc |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WATCHFUL |
11u |
Have you been bothered by that problem in the PAST MONTH. Being “super alert” or |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
ALERT |
11v |
Have you been bothered by that problem in the PAST MONTH. Feeling jumpy or easil |
0=Not at all, 1=A little bit, 2=Moderately, 3=Quit |
MENTAL_HEALTH |
Exact Match (all same field name)
|
LIFE_DIFFICULT |
11w |
How difficult have these problems (11f. through 11v.) made it for you to do your |
0=Not difficult at all, 1=Somewhat difficult, 2=Ve |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_LITTLE_INTEREST |
12a |
Over the LAST 2 WEEKS, how often have you been bothered by the following problem |
0=Not at all, 1=Few or several days, 3=More than h |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_DEPRESSED |
12b |
Over the LAST 2 WEEKS, how often have you been bothered by the following problem |
0=Not at all, 1=Few or several days, 3=More than h |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_SLEEP |
12c |
Over the LAST 2 WEEKS, how often have you been bothered by the following problem |
0=Not at all, 1=Few or several days, 3=More than h |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_TIRED |
12d |
Over the LAST 2 WEEKS, how often have you been bothered by the following problem |
0=Not at all, 1=Few or several days, 3=More than h |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_APPETITE |
12e |
Over the LAST 2 WEEKS, how often have you been bothered by the following problem |
0=Not at all, 1=Few or several days, 3=More than h |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_FAILURE |
12f |
Over the LAST 2 WEEKS, how often have you been bothered by the following problem |
0=Not at all, 1=Few or several days, 3=More than h |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_CONCENTRATE |
12g |
Over the LAST 2 WEEKS, how often have you been bothered by the following problem |
0=Not at all, 1=Few or several days, 3=More than h |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_LETHARGIC_JUMPY |
12h |
Over the LAST 2 WEEKS, how often have you been bothered by the following problem |
0=Not at all, 1=Few or several days, 3=More than h |
MENTAL_HEALTH |
Exact Match (all same field name)
|
WEEKS_PROBLEMS |
12i |
How difficult have these problems (12a.through12h.) made it for you to do your w |
0=Not difficult at all, 1=Somewhat difficult, 2=Ve |
MENTAL_HEALTH |
Exact Match (all same field name)
|
STRESSOR_NONE |
13a |
Over the PAST MONTH, which major life stressors, if any, have you experienced th |
1=Checked (None), 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_LEGAL |
13a |
Legal |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_MONEY |
13a |
Financial |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_SPIRIT |
13a |
Spiritual |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_SUB |
13a |
Substance abuse (including alcohol) |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_FAM |
13a |
Family/relationship |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_WORK |
13a |
Employment |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_SLEEP |
13a |
Sleep |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_MH |
13a |
Behavioral health |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSOR_OTH |
13a |
Other |
1=Checked, 0=Not Checked |
STRESSORS |
Exact Match (all same field name)
|
STRESSORS_TEXT |
13a |
Please list and explain |
Text Field |
STRESSORS |
Exact Match (all same field name)
|
STRESSORS_HELP |
13b |
Are you currently in treatment or getting professional help for this concern? |
Y=Yes, N=No, blank=missing |
STRESSORS |
Exact Match (all same field name)
|
CONCERN_OTHER |
14 |
Are you concerned about any other health condition(s) or health risk exposures n |
Y=Yes, N=No (None) |
OTHER |
Unique to DD2795
|
CONCERN_TEXT |
14 |
Please list and explain |
Text Field |
OTHER |
Unique to DD2795
|
HCP_LNAME |
HCP1 |
HCP provider's Last Name |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_FNAME |
HCP2 |
HCP provider's First Name |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_MNAME |
HCP3 |
HCP provider's Middle Name |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_SERVICE |
HCP4 |
HCP provider's Service Branch |
F=Air Force, A=Army, N=Navy, M=Marine Corps, S=Spa |
DEPLOYMENT |
Exact Match (all same field name)
|
HCP_STATUS |
HCP5 |
HCP provider's Status |
A=AD, G=Guard, R=Reservist, AGR=AGR, CIV=Civ, CTR= |
PROVIDER |
Exact Match (all same field name)
|
HCP_STATUS_TEXT |
HCP5 |
HCP provider's Status Text |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_TITLE |
HCP6 |
HCP provider's Title |
PHY=MD/DO, NP=NP, PA=PA, APN=APN, IDC=IDC, IDHST=I |
PROVIDER |
Exact Match (all same field name)
|
HCP_EMAIL |
HCP7 |
HCP provider's Email |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_FACILITY |
HCP8 |
Facility Name |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_UNIT |
HCP9 |
Unit Name |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_ADDR |
HCP10 |
HCP provider's Address and City |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_STATE |
HCP11 |
HCP provider's STATE |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_ZIP |
HCP12 |
HCP provider's ZIP Code |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
HCP_PHONE |
HCP13 |
HCP provider's Phone number |
Text Field |
PROVIDER |
Exact Match (all same field name)
|
DEPLOYING_TO_PROVIDER |
META |
Providers input |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
HAS_DEPLOYED_PROVIDER |
META |
Providers input |
0-99 |
DEPLOYMENT |
Unique to DD2795
|
LAST_RETURNED_PROVIDER |
META |
Providers input |
YYYYMMDD |
OTHER |
Unique to DD2795
|
SELF_HEALTH_FOLLOWUP |
HP1 |
Self health rating |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Exact Match (all same field name)
|
SELF_HEALTH_DEPLOYER |
HP1 |
Self health rating Deployers Response |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
SELF_HEALTH_PROVIDER |
HP1 |
Self health rating Providers comments |
Text Field |
OTHER |
Unique to DD2795
|
MEB_FOLLOWUP |
HP1 |
MEB or PEB |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
MEB_DEPLOYER |
HP1 |
MEB or PEB |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
MEB_PROVIDER |
HP1 |
MEB or PEB |
Text Field |
OTHER |
Unique to DD2795
|
MDM_FOLLOWUP |
HP1 |
Medical, dental, or mental health concern |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
MDM_DEPLOYER |
HP1 |
Medical, dental, or mental health concern |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
MDM_PROVIDER |
HP1 |
Medical, dental, or mental health concern |
Text Field |
OTHER |
Unique to DD2795
|
PREGNANT_FOLLOWUP |
HP1 |
I am or may be pregnant |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
PREGNANT_DEPLOYER |
HP1 |
I am or may be pregnant |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
PREGNANT_PROVIDER |
HP1 |
I am or may be pregnant |
Text Field |
OTHER |
Unique to DD2795
|
DELIVERED6_FOLLOWUP |
HP1 |
Pregnant or just delivered within the past 6-months |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
DELIVERED6_DEPLOYER |
HP1 |
Pregnant or just delivered within the past 6-months |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
DELIVERED6_PROVIDER |
HP1 |
Pregnant or just delivered within the past 6-months |
Text Field |
OTHER |
Unique to DD2795
|
DELIVERED12_FOLLOWUP |
HP1 |
Pregnant and delivered 6 ~ 12 months ago |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
DELIVERED12_DEPLOYER |
HP1 |
Pregnant and delivered 6 ~ 12 months ago |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
DELIVERED12_PROVIDER |
HP1 |
Pregnant and delivered 6 ~ 12 months ago |
Text Field |
OTHER |
Unique to DD2795
|
DELIVERED00_FOLLOWUP |
HP1 |
Not pregnant or delivered in past 12 months |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
DELIVERED00_DEPLOYER |
HP1 |
Not pregnant or delivered in past 12 months |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
DELIVERED00_PROVIDER |
HP1 |
Not pregnant or delivered in past 12 months |
Text Field |
OTHER |
Unique to DD2795
|
CONTRA_COUNSEL_FOLLOWUP |
HP1 |
Contraceptive counseling |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
CONTRA_COUNSEL_DEPLOYER |
HP1 |
Contraceptive counseling |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
CONTRA_COUNSEL_PROVIDER |
HP1 |
Contraceptive counseling |
Text Field |
OTHER |
Unique to DD2795
|
HEAD_FOLLOWUP |
HP1 |
Head injury |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
HEAD_DEPLOYER |
HP1 |
Head injury |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
HEAD_PROVIDER |
HP1 |
Head injury |
Text Field |
OTHER |
Unique to DD2795
|
MED_FOLLOWUP |
HP1 |
Medications |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
MED_DEPLOYER |
HP1 |
Medications |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
MED_PROVIDER |
HP1 |
Medications |
Text Field |
OTHER |
Unique to DD2795
|
HX_MH_FOLLOWUP |
HP1 |
History of mental Health Care |
0=Not answered, 1=Deployer indicated concern or ye |
OTHER |
Unique to DD2795
|
HX_MH_DEPLOYER |
HP1 |
History of mental Health Care |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
HX_MH_PROVIDER |
HP1 |
History of mental Health Care |
Text Field |
OTHER |
Unique to DD2795
|
HEARING_REPORTED |
HP2a |
Did deployer mark he/she bothered by noises in ears or trouble hearing |
Y=Yes, N=No, blank=missing |
PHYSICAL_SYMPTOMS |
Unique to DD2795
|
REF_HEARING |
HP2b |
Is referral indicated for hearing problem |
Y=Yes, N=No, blank=missing |
PHYSICAL_SYMPTOMS |
Unique to DD2795
|
REF_HEARING_NEG |
HP2b |
Why not referred |
1=Already under care, 2=Already has referral, 3=no |
PHYSICAL_SYMPTOMS |
Unique to DD2795
|
REF_HEARING_TEXT |
HP2b |
Other reason for referral |
Text Field |
PHYSICAL_SYMPTOMS |
Unique to DD2795
|
AUDITC_SCREEN |
HP3a |
Deployer's AUDIT-C screening score |
0-12, N=not answered, blank=missing |
SUBSTANCE_USE |
Exact Match (all same field name)
|
ETOH_WEEK_PROVIDER |
HP3a |
Number of drinks per week |
0-99 |
SUBSTANCE_USE |
Exact Match (all same field name)
|
ETOH_TOTAL_PROVIDER |
HP3a |
Number of drinks per occasion |
0-99 |
SUBSTANCE_USE |
Exact Match (all same field name)
|
REF_ETOH |
HP3b |
Referral indicated for evaluation ETOH |
Y=Yes, N=No, blank=missing |
SUBSTANCE_USE |
Exact Match (all same field name)
|
REF_ETOH_NEG |
HP3b |
Reason for no referral |
1=Already under care, 2=Already has referral, 3=no |
SUBSTANCE_USE |
Exact Match (all same field name)
|
REF_ETOH_TEXT |
HP3b |
Other reason for referral |
Text Field |
SUBSTANCE_USE |
Exact Match (all same field name)
|
PTSD_REPORTED |
HP4a |
Did deployer mark yes on three or more of questions 11a. through 11e? |
Y=Yes, N=No, X=Not answered by deployer, blank=mis |
MENTAL_HEALTH |
Exact Match (all same field name)
|
PCLC_SCORE |
HP4b |
If yes, deployer’s responses to questions 11f. through 11v. resulted in a PCL-C |
0-99, X=not answered or incomplete, blank=missing |
MENTAL_HEALTH |
Semantic Match – All 3 Schemas
|
PCLC_INCOMPLETE |
HP4b |
11f. through 11w. were not answered or are incomplete |
1=Checked, 0=Not Checked |
MENTAL_HEALTH |
Exact Match (all same field name)
|
PCLC_MATRIX |
HP4b |
PTSD Intervention Matrix, Self-Reported Level of Functioning |
1 - Not difficult at all or somewhat difficult; 2= |
MENTAL_HEALTH |
Semantic Match – All 3 Schemas
|
REF_PTSD |
HP4c |
Referral indicated for PTSD |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
REF_PTSD_NEG |
HP4c |
Reason for no referral |
1=Already under care, 2=Already has referral, 3=no |
MENTAL_HEALTH |
Exact Match (all same field name)
|
REF_PTSD_TEXT |
HP4c |
Other reason for referral |
Text Field |
MENTAL_HEALTH |
Exact Match (all same field name)
|
DEPRESSION_REPORTED |
HP5a |
Did deployer mark “More than half the days” or “Nearly every day” on question 12 |
Y=Yes, N=No, X=Not answered by deployer, blank=mis |
MENTAL_HEALTH |
Exact Match (all same field name)
|
PHQ8_SCORE |
HP5b |
If yes, deployer’s responses to questions 12a. through 12h. resulted in a total |
0-99, X=12c-12i not answered or incomplete, blank= |
MENTAL_HEALTH |
Semantic Match – All 3 Schemas
|
PHQ8_INCOMPLETE |
HP5b |
11c. through 11i. were not answered or incomplete. |
1=Checked, 0=Not Checked |
MENTAL_HEALTH |
Exact Match (all same field name)
|
PHQ8_MATRIX |
HP5b |
Depression Intervention Matrix, Self-Reported Level of Functioning |
1 - Not difficult at all or somewhat difficult; 2= |
MENTAL_HEALTH |
Exact Match (all same field name)
|
REF_DEPRESSION |
HP5c |
Referral for depression education |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
REF_DEPRESSION_NEG |
HP5c |
Reason for no referral |
1=Already under care, 2=Already has referral, 3=no |
MENTAL_HEALTH |
Exact Match (all same field name)
|
REF_DEPRESSION_TEXT |
HP5c |
Other reason for referral |
Text Field |
MENTAL_HEALTH |
Exact Match (all same field name)
|
STRESSORS_REPORTED |
HP6a |
Did deployer mark they have a concern or a difficulty with a major life stressor |
Y=Yes, N=No, X=Not answered by deployer, blank=mis |
STRESSORS |
Unique to DD2795
|
STRESSORS_DEPLOYERS_CONCERN |
HP6a |
Deployer's Concern |
Text Field |
DEPLOYMENT |
Unique to DD2795
|
STRESSORS_COMMENTS |
HP6b |
If yes, ask additional questions to determine level of problem: |
Text Field |
STRESSORS |
Unique to DD2795
|
REF_STRESSORS |
HP6c |
Referral for STRESSORS |
Y=Yes, N=No, blank=missing |
STRESSORS |
Unique to DD2795
|
REF_STRESSORS_NEG |
HP6c |
Reason for no referral |
1=Already under care, 2=Already has referral, 3=no |
STRESSORS |
Unique to DD2795
|
REF_STRESSORS_OTHER |
HP6c |
Other reason for referral |
Text Field |
STRESSORS |
Unique to DD2795
|
SUICIDE_A |
HP7a |
Over the PAST MONTH, have you wished you were dead or wished you could go to sle |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_B |
HP7b |
Have you actually had any thoughts of killing yourself? |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_C |
HP7c |
Over the PAST MONTH, have you been thinking about how you might do this? |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_D |
HP7d |
Over the PAST MONTH, have you had these thoughts and had some intention of actin |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_E1 |
HP7e1 |
Over the PAST MONTH, have you started to work out or worked out the details of h |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_E2 |
HP7e2 |
At any time in the PAST MONTH, did you intend to carry out this plan? |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_F1 |
HP7f1 |
In your lifetime, have you ever done anything, started to do anything, or prepar |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_F2 |
HP7f2 |
Was this within the past three months? |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_G_TEXT |
HP7g |
Conduct further risk assessment |
Text Field |
MENTAL_HEALTH |
Exact Match (all same field name)
|
SUICIDE_RISK |
HP7h |
Does deployer pose a current risk for harm to self? |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
VIOLENCE |
HP8a |
Over the past month have you had thoughts or concerns that you might hurt or los |
Y=Yes, N=No, blank=missing |
OTHER |
Exact Match (all same field name)
|
VIOLENCE_TEXT |
HP8a |
Comments on violence/harm eval |
Text Field |
OTHER |
Exact Match (all same field name)
|
VIOLENCE_RISK |
HP8b |
Does member pose a current risk to others? |
Y=Yes, N=No, blank=missing |
OTHER |
Exact Match (all same field name)
|
VIOLENCE_RISK_TEXT |
HP8b |
Explain 8B |
Text Field |
OTHER |
Exact Match (all same field name)
|
MED_HX_REV |
HP9 |
Medical History Review |
1=Completed, 2=No health records available, blank= |
OTHER |
Unique to DD2795
|
SIGNIF_FDN |
HP9a |
Significant findings |
Text Field |
OTHER |
Unique to DD2795
|
MED_LIMIT_DEPLOY |
HP9b |
Evidence of deployment limiting condition |
Y=Yes, N=No, blank=missing |
DEPLOYMENT |
Unique to DD2795
|
DEP_DEC_FORM |
HP10 |
Deployer declined to complete form |
1=Checked, 0=Not Checked |
OTHER |
Exact Match (all same field name)
|
DEP_DEC_ASSESS |
HP10 |
Deployer declined to complete interview |
1=Checked, 0=Not Checked |
OTHER |
Exact Match (all same field name)
|
REFER_NONE |
HP11a |
No concerns identified |
1=Checked, 0=Not Checked |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFER_PH |
HP11b |
Concerns identified: Physical health |
Y=Yes, N=No, blank=missing |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFER_DENTAL |
HP11c |
Concerns identified: Dental health |
Y=Yes, N=No, blank=missing |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFER_ETOH |
HP11d |
Concerns identified: Alcohol use |
Y=Yes, N=No, blank=missing |
SUBSTANCE_USE |
Exact Match (all same field name)
|
REFER_PTSD |
HP11e |
Concerns identified: PTSD symptoms |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
REFER_DEPRESSION |
HP11f |
Concerns identified: Depression symptoms |
Y=Yes, N=No, blank=missing |
MENTAL_HEALTH |
Exact Match (all same field name)
|
REFER_MH |
HP11g |
Concerns identified: Mental health symptoms |
Y=Yes, N=No, blank=missing |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFER_HARM |
HP11h |
Concerns identified: Risk of self-harm |
Y=Yes, N=No, blank=missing |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFER_VIOLENCE |
HP11i |
Concerns identified: Risk of violence |
Y=Yes, N=No, blank=missing |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFER_OTHER |
HP11j |
Concerns identified: Other |
Y=Yes, N=No, blank=missing |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFER_OTHER_TEXT |
HP11j |
Concerns identified: Other (list) |
Text Field |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_PRIMARY |
HP12a |
Referral indicated - Primary Care, Family Practice, Internal Medicine |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_MENTAL_PRIMARY |
HP12b |
Referral indicated - Behavioral Health in Primary Care |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_MENTAL_SPECIAL |
HP12c |
Referral indicated - Mental Health |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_DENTAL |
HP12d |
Referral indicated - Dental |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_OTHER_SPEC |
HP12e |
Referral indicated - Other specialty care |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_AUDIOLOGY |
HP12e |
Referral indicated - Audiology |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_DERM |
HP12e |
Referral indicated - dermatologic |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_GYN |
HP12e |
Referral indicated - OB/GYN |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_PT |
HP12e |
Referral indicated - PT |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_TBI |
HP12e |
Referral indicated -TBI/Rehab Med |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_PODIATRY |
HP12e |
Referral indicated - Podiatry |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_SPEC_OTHER |
HP12e |
Referral to other specialty care listed |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_SPEC_OTH_TEXT |
HP12e |
List of other specialty referral |
Text Field |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_CARE |
HP12f |
Referral to Case manager |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_ABUSE |
HP12g |
Referral to Substance abuse program |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_OTHER |
HP12h |
Other referral listed |
0=Within 24 hours, 1=Within 7 days, 2=Within 30 da |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_OTHER_TEXT |
HP12h |
List of other specialty referral |
Text Field |
REFERRAL_ACTION |
Exact Match (all same field name)
|
REFTIME_COMMENTS |
HP13 |
Referral comments |
Text Field |
REFERRAL_ACTION |
Exact Match (all same field name)
|
MED_DISP |
HP14 |
Final Medical Disposition |
1=deployable, 2=Deployable with conditions, 3=not |
OTHER |
Unique to DD2795
|
MED_DISP_TEXT |
HP15 |
Medical Disposition Comments |
Text Field |
OTHER |
Unique to DD2795
|
APPOINTMENT_ASSIST |
HP16 |
Appointment Assistance |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
APPOINT_ASSIST_TEXT |
HP16 |
Appointment assistance text |
Text Field |
ADMIN |
Unique to DD2795
|
CONTRACT_SUP |
HP16 |
Contract support |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
CONTRACT_SUP_TEXT |
HP16 |
Contract support text |
Text Field |
ADMIN |
Exact Match (all same field name)
|
COMMUNITY |
HP16 |
Community Service |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
COMMUNITY_TEXT |
HP16 |
Community Service text |
Text Field |
ADMIN |
Exact Match (all same field name)
|
CHAPLAIN |
HP16 |
Chaplain |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
HEALTH_ED |
HP16 |
Health Education and Information |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
HEALTH_RESOURCES |
HP16 |
Health Care Benefits and Resources Information |
Y=Checked, N=Not checked |
OTHER |
Exact Match (all same field name)
|
IN_TRANS |
HP16 |
In Transition |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
FAM_SUPPORT |
HP16 |
Family Support |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
ONE_SOURCE |
HP16 |
Military one source |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
TRICARE |
HP16 |
TRICARE PROVIDER |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
VA_MED |
HP16 |
VA Medical Center or Community Clinic |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
VET |
HP16 |
Vet Center |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
OTHER_SUPPORT |
HP16 |
Other Supplemental services recommended |
Y=Checked, N=Not checked |
OTHER |
Exact Match (all same field name)
|
OTHER_SUPPORT_TEXT |
HP16 |
Other Supplemental services recommended text |
Text Field |
OTHER |
Exact Match (all same field name)
|
APPOINTMENT_NONE |
HP16 |
No Supplemental Services Required |
Y=Checked, N=Not checked |
ADMIN |
Exact Match (all same field name)
|
CERT_PROVIDER |
META |
Certify review process has been completed |
1=Checked, 0=Not Checked |
ADMIN |
Exact Match (all same field name)
|
HCP_DIG_SIG |
META |
HCP Digital Signature |
1=Signed, 0=Not signed |
PROVIDER |
Exact Match (all same field name)
|
CERTIFY_DATE |
META |
Date Certified |
YYYYMMDD |
ADMIN |
Exact Match (all same field name)
|