Download DA Form 8003, also known as Army Substance Abuse Program (ASAP) Enrollment. This form is a referral and to be completed by medical doctors, nurses or military medical staff. The form, once completed, will provide information to assist medical staff decide if a patient should be enrolled in the program.
Step 1 – Complete blocks 1 through 5 for patient information:
- 1. Name (Last, First, MI)
- 2. Rank/Grade
- 3. Social Security Number
- 4. Date of Birth (yyyy/mm/dd format)
- 5. Yrs Act/Fed Svc
Step 2 – Complete questions 6 through 11 by reading the question and checking the appropriate box- inside each block:
- 6. Is Servicemember/Employee expected to depart installation within 90 days? (y/n)
- 7. Is Servicemember/Employee on flying status? (y/n)
- 8. Is Servicemember/Employee involved in Personnel Reliability Program? (y/n)
- 9. Type of Referral: Biochemical – Check each appropriate box and supply any test results.
- 10. Record of Civilian Arrests/Convictions, Courts Martial, Company Punishments, and Disciplinary Problems, including those Pending: (Specific dates and offenses) type or write into the block provided.
- 11. Performance: (Give specifics of fair or unsatisfactory ratings)
Step 3 – Reasons for Referral: (Check all appropriate spaces in columns a.b. and c.-
Step 4 – Patient Identification – For typed or written entries provide all required information as stated on the form
Step 5- 14. Addresses other problem experienced by a soldier or employee – check appropriate boxes.
Step 6 – 15. Is19. Phone soldier/employee seen by other helping agencies? Check appropriate box
Step 7 – 17. though 19 request immediate supervisor and commander’s information –
- 17. Immediate Supervisor’s Name
- 18. Date yyyy/mm/dd
- 19. Phone
- 20. Commander’s/Supervisor’s Signature
- 21. Date yyyy/mm/dd
- 22. Phone
Step 8 – Rehabilitation Team Meeting Results –
- Record of contact with commanders/supervisors concerning this referral – Record face-to-face rehabilitation team meeting results or telephone concurrences, to include dates of programmatic agreements.
- Note: Results of rehabilitation team meetings must also be recorded on SF 600
Step 9 – Note: For Federal Employees – To be completed ONLY with written consent of employee:
- Date yyyy/mm/dd
- Complete form by checking the remaining boxes and filling in the lines in the final block.