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DA Form 3822 is a Department of the Army form in the DA series. Title of record: REPORT OF MENTAL STATUS EVALUATION. Function: report of mental status evaluation. The edition presently published bears the date 06/01/2019, with a status of ACTIVE. Physical extent is 1 page(s) and about 200 fillable fields.
Proponency for the form rests with TSG. The governing authority is AR 40-66, which establishes the circumstances of use and the required routing. Preparation falls to the individual named in the entries or to the unit administrator acting on that individual's behalf; review and signature follow the chain set out in the governing authority.
Formats offered: PDF, XFDL. All are the same published layout in different containers, and the choice between them is a matter of how the entries will be made rather than what appears on the page. The pdf serves as the authoritative rendering. A fillable pdf exposes editable fields on screen; a printable pdf is the blank form as a flat page for handwriting.
The pdf displays in current browsers and in any reader application. For fillable use a full reader is preferable to a browser viewer, since viewers vary in whether entered data is retained. An xfdl file is available too. The format is IBM Lotus Forms, in use across Army form systems, and it opens only in the Lotus Forms Viewer.
All formats are free to download and no registration is involved. The files are the published documents, distributed unmodified.
What the form asks for
- BH_Date
- BH_Diagnoses
- Behavior_Abnormal
- Behavior_Normal
- Behavioral_Health_Provider
- Behavioral_Health_Supervisor
- Ch.1014Officerelim
- Chapter5_13
- Chapter5_17
- Check1
- Check2
- Check3
- Check4
- Check5
- Check6
- Check7
- Check8
- Check_Evaluation_Other
- Clinic
- Clinic1
- Clinic2
- Cognition_Abnormal
- Cognition_Normal
- Command_Referral
The blocks are worked through in the order they appear on the sheet. At the head sit the identifying entries: name, identification number, unit, date. Because the filed record is indexed on these, they precede everything substantive.
Typed entry is made straight into the interactive fields. The tab key moves through them in the order set at build time, generally matching the reading order of the page. Boxes and buttons respond to a click; in an exclusive group, one selection cancels the others. Single-line fields do not wrap, and anything longer than the field width prints cut off although it may still display in full on screen. Extended text goes to remarks or a continuation sheet rather than into a narrow box.
The signature block is the final entry, made by hand or by an authorised electronic method, and without it the document remains a draft. Countersignatures — review, approval, witness — are added in the sequence printed, dated at the moment of signing and not at preparation. Empty mandatory fields lead the list of defects; an inapplicable field is annotated as such, not passed over. Behind it come digit transposition in identification numbers, day-month inversion in dates, and residual entries surviving from a reused copy in place of a blank form.
Where personal information is gathered, the form carries a Privacy Act statement giving the collection authority, the purpose, the routine uses, and the mandatory or voluntary character of the disclosure. It is read before entries are made rather than afterwards. A completed copy holds personal data and is stored and transmitted under the corresponding safeguards.
Once completed, the form goes where the governing authority directs: to the designated office, along the unit administrative channel, or into the personal file. The preparer retains a copy. The length of retention and the manner of filing are set by the records schedule for the series, not by local arrangement.
Companion forms are traced by series and number. Within the DA series, documents sharing a proponent or a governing directive are frequently required together, and a form cited on the face of another is generally submitted alongside it. Continuation sheets, covers, and transmittal forms are part of that set and are assembled in advance of submission.
Revision by the proponent supersedes an edition. Version is read from the edition date printed on the form itself, and a stored copy is compared against the current edition before it is used again. Documents already executed under an earlier edition are not redone because of the change.
The documents on this page are reproductions of published Department of the Army forms, offered for download. This is an independent site with no connection to the Department of the Army and no authority to issue forms. Nothing stated is legal advice, and no assurance is given regarding acceptance by any office. Doubts about a specific entry, requirement, or eligibility are resolved by the proponent or by the servicing administrative office.
Questions and answers
- What is DA Form 3822?
- REPORT OF MENTAL STATUS EVALUATION
- Which edition is current?
- 06/01/2019
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF