How to Fill Out and Submit DA Form 3822: Mental Status Evaluation

DA Form 3822, Report of Mental Status Evaluation, is completed by a credentialed Army behavioral health provider during a mental status evaluation and returned to the requesting commander in a sealed “Commander’s Eyes Only” envelope within one business day.¹ The form is a two-page fillable PDF with a patient information header and six numbered sections. Its proponent is the Office of the Surgeon General, and its use is governed by AR 40-66.²

When You Use This Form

DA Form 3822 is the only authorized form for documenting the results of a command-directed behavioral health evaluation (CDBHE) back to the commander.²³⁴ Typical triggers are fitness-for-duty concerns, significant performance changes, safety issues, or behavior suggesting a possible change in mental status.

The form is also required during administrative separations processed under AR 635-200, Chapter 5-13 (personality disorder) or Chapter 5-17 (other mental conditions not amounting to a disability). Both are listed as built-in reasons in Section I.² In those cases, the evaluation determines whether the soldier meets medical retention standards under AR 40-501 or should instead be referred into the Disability Evaluation System.

Getting the Current Edition

Use the JUN 2019 edition, available through the Army Publishing Directorate at armypubs.army.mil. Previous editions are obsolete. It’s a two-page fillable PDF and can be completed digitally or printed and filled by hand.²

Filling Out the Form

Patient Information Header

Enter the soldier’s name, rank or grade, status, date of birth in YYYYMMDD format, Sponsor DOD ID, date of the evaluation, the military treatment facility (MTF) where it takes place, a name prefix, and a phone number. The form asks for a DOD ID number, not a Social Security number.²

Section I. Reason for Behavioral Health Evaluation

Identify why the evaluation is happening. Select Chapter 5-13 or 5-17 under AR 635-200, specify a different reason under “Other,” or choose from the dropdown labeled “Select Reason for MSE.” Get this right. The reason drives which checkboxes are relevant later in Section II.²

Section II. Behavioral Health Disposition Determination

This is the bottom-line answer the commander is waiting for. The provider selects among checkboxes covering the possible outcomes:

No evidence of an impairing behavioral health condition; cleared for advanced military training.
Meets medical retention standards under AR 40-501, with no behavioral health duty limitations.
Has reached the medical retention determination point; Disability Evaluation System referral indicated.
Meets criteria for a Chapter 5-13 or 5-17 administrative separation but currently meets medical retention standards.
Further assessment needed before a readiness determination can be made.
Meets retention standards but may require a deployability waiver for specific areas of operation.

Also document whether the soldier deployed to an imminent danger pay area, which may require OTSG-level approval using a Behavioral Health Activity Report, and confirm there is no evidence of a diagnosis change from a boardable to a non-boardable condition within the past 90 days.²

Section III. Pertinent Findings on Mental Status Evaluation

Mark each clinical domain:

Behavior: Normal or Abnormal
Cognition: Not Impaired or Impaired
Impulsivity: Not Impaired or Impaired
Perceptions: Normal or Abnormal
Risk for harm to self: Not Elevated, Low, Intermediate, or High
Risk for harm to others: Not Elevated, Low, Intermediate, or High

Screening checkboxes cover substance misuse, sexual trauma, traumatic brain injury, PTSD, and depression. Mark whether screenings were performed and whether any results were positive or elevated.²

Section IV. Diagnoses

Record any behavioral health diagnoses and any other relevant medical diagnoses. The form specifically prompts for traumatic brain injury, PTSD, and depression as named conditions, with open fields for anything else.

Section V. Follow-Up Recommendations

Choose one of three options: no follow-up needed, follow-up recommended, or follow-up as already scheduled. If follow-up is needed, fill in the clinic, location, date, and time. Two additional checkboxes let the provider recommend a command referral to the Family Advocacy Program or a Substance Use Disorder evaluation.²

Section VI. Recommendations and Comments for Commander

Answer three yes-or-no questions:

Whether the soldier’s behavioral health condition was likely a mitigating factor in the alleged behavior leading to administrative separation.
Whether safety precautions are indicated.
Whether the soldier can understand and participate in administrative proceedings and appreciate the difference between right and wrong.

That last item matters for separation proceedings. If the provider determines the soldier cannot meaningfully participate, the administrative action may need to be paused or redirected.²

Who Signs

DA Form 3822 must be signed by a credentialed mental health professional with clinical privileges to conduct the evaluation: a psychiatrist, a doctoral-level psychologist, or a licensed clinical social worker.⁵ A separate line captures the behavioral health supervisor’s signature when the evaluation was completed under supervision.²

Submitting the Completed Form

Once signed, place the completed form in an envelope marked “Commander’s Eyes Only” and call the unit to pick it up. AR 40-66 requires disclosure accounting whenever the form is released.⁶ The written response goes to the commander or supervisor within one business day of completing the evaluation.¹

What the commander receives is limited to what appears on the form: diagnosis, prognosis, treatment recommendations, fitness for continued service, and safety precautions. Detailed therapy notes and session content are not included. The form also becomes part of the soldier’s medical record at the MTF, with the same Privacy Act and HIPAA protections that apply to all military health records. Protected health information on the form may be used for treatment, payment, and healthcare operations, and may be shared outside DoD in accordance with the Privacy Act of 1974.⁷

What the Commander Does With It

The next step depends on the disposition marked in Section II. A finding that the soldier meets retention standards with no follow-up needed lets the administrative action proceed on its original timeline. A Chapter 5-13 or 5-17 finding supports the separation packet. A finding that the soldier does not meet medical retention standards routes the case into the Disability Evaluation System rather than a routine administrative separation. A “further assessment needed” finding pauses the timeline until a definitive determination is possible. The Section VI mitigating-factor answer becomes part of the record a separation board or reviewing authority weighs, though it does not automatically stop a separation.

Soldier Protections to Be Aware Of

A command-directed evaluation carries the weight of a lawful order under DoDI 6490.04, and refusing to attend can be treated as failure to obey under the UCMJ.⁴ The instruction also builds in protections worth knowing:

If the evaluation leads to inpatient admission, the soldier has the right to have a judge advocate or personal attorney present during the independent medical review.
After admission, the soldier may contact a relative, friend, chaplain, attorney, or Inspector General office as soon as their condition permits.
A soldier who believes the CDBHE is retaliation for a protected communication may file a complaint with the DoD IG Hotline or a Military Department IG.

Soldiers may also request a second opinion through TRICARE; active duty service members and TRICARE Prime beneficiaries request one through their primary care manager.⁸ A second opinion does not override the original DA Form 3822, but it creates an additional record that can be considered during separation proceedings or a Medical Evaluation Board.

1
Joint Base San Antonio. Behavioral Health Information for Commanders
2
Army Publishing Directorate. DA Form 3822 – Report of Mental Status Evaluation
3
United States Forces Korea. Army Regulation 600-20 – Army Command Policy
4
Department of Defense. DoDI 6490.04 – Mental Health Evaluations of Members of the Military Services
5
Center for Deployment Psychology. DA Form 3822 Mental Status Evaluation
6
Georgia Army National Guard. AR 40-66 – Medical Record Administration and Healthcare Documentation
7
Executive Services Directorate. DD Form 2978 – Mental Health Assessment
8
TRICARE. Second Opinion