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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:

  • To:
  • From:
  • Date yyyy/mm/dd
  • Complete form by checking the remaining boxes and filling in the lines in the final block.

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