Form Navpers 5350/3 - Dapa Admin Screening Form - Navpers Form
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10FILLABLE FORM
DAPA ADMIN SCREENING FORM
Servicemember Name:
Supporting Directive OPNAVINST 5350-4D
ADMINISTRATIVE SCREENING CHECKLIST
Date Completed
Comments
Action
Member identified
Notify C.O. (if required)
Collect service record
Page 9 -10 delivered to
member's supervisor
Supervisor input returned
Initial DAAR submitted within
30 days (Reservists 90 days)
Member appointmemt
scheduled (member and
supervisor notified)
Member interview conducted
C.O. notified (if required) of
DAPA recommendations
MTF appointment scheduled
Member/supervisor notified of
appointment and MTF
requirements (uniform etc.)
Admin screening form/records
delivered to MTF
Recommendations/diagnosis
received from MTF
C.O. notified of diagnosis
Member notified on treatment
program requirements
Final DAAR submitted (upon
member's completion of
formal treatment)
Continuing Care (Aftercare)
Plan received (after member
completes treatment)
Initial Aftercare meeting held;
member notified of Aftercare
requirements
Aftercare Exit interview
completed
This checklist is only a guide. DAPAs must liaise with local MTF on
specific requirements for the area.
NAVPERS 5350/3 (Revised 08-09)
FOR OFFICIAL USE ONLY
PAGE 1 OF 10
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