AF Form 696: Dental Patient Medical History Guide & Download

AF Form 696: Dental Patient Medical History Guide & Download – If you’re an active duty Airman, dependent, or retiree seeking dental care at a U.S. Air Force clinic, you will likely complete AF Form 696, Dental Patient Medical History. This essential form helps Air Force dentists deliver safe, personalized treatment while protecting patient health.

What Is AF Form 696?

AF Form 696 is the official U.S. Air Force form titled “Dental Patient Medical History.” It collects critical health information before any dental examination or procedure. Dentists use it to identify medical conditions, allergies, medications, or other factors that could affect treatment safety.

The current version (dated 20090401, often marked as an interim form) remains in active use across Air Force dental treatment facilities (DTFs). It pairs with other records like SF 603/603A (Dental Health Record) and DD Form 2005 (Privacy Act Statement).

Why Is AF Form 696 Important?

Air Force dental care follows strict protocols under guidelines like AFMAN 47-101 (Managing Air Force Dental Services). The form serves several key purposes:

  • Safety First — Identifies risks such as allergies to local anesthetics, latex, or antibiotics; heart conditions requiring premedication; or pregnancy status.
  • Comprehensive Care — Allows dentists to review overall health, tobacco use, blood pressure, and conditions like diabetes or bleeding disorders that impact procedures.
  • Legal & Privacy Compliance — Subject to the Privacy Act of 1974; completed in ink with patient or guardian signature.
  • Record Keeping — Becomes part of the permanent dental health record for continuity of care, deployments, or transfers.

Accurate completion prevents complications during cleanings, extractions, fillings, or sedation.

What Information Does AF Form 696 Collect?

The one-page form (with continuation sheet) asks for:

  • Patient Details — Name, SSN, sponsor info, contact details, organization/unit.
  • General Health — Impression of current health, last medical physical, blood pressure readings.
  • Medical History — Circle applicable conditions (heart disease, diabetes, asthma, high blood pressure, arthritis, etc.).
  • Yes/No Questions — Physician care, current medications/supplements, allergies, reactions to anesthetics, prior dental complications, tobacco use (type and frequency), pregnancy (for women).
  • Additional Sections — Flying status or special duty (for active duty), dentist comments, multiple reviewer signatures and dates.

Patients should answer honestly and provide details on the back or continuation sheet if needed. Dental staff review positive responses and initial the form.

Who Needs to Complete AF Form 696?

  • Active duty Air Force members (required for routine exams and treatment).
  • Dependents and retirees receiving care at military dental clinics.
  • New patients or those with updated health changes.
  • Anyone undergoing procedures involving anesthesia, surgery, or radiographs.

Dental assistants often guide patients through completion during initial visits or record initiation.

How to Fill Out and Use AF Form 696?

  1. Complete in Ink — Print clearly; use black or blue pen.
  2. Be Thorough — Circle “Yes” for any relevant items and explain details.
  3. Sign and Date — Patient (or guardian) signature required.
  4. Review Process — Dental provider discusses entries, takes blood pressure, and notes findings.
  5. File It — Placed in the dental record (AF Form 2100B series folder or electronic equivalent in MHS GENESIS).

Bring updates for medications, surgeries, or conditions at every visit. Many clinics integrate this with electronic health records.

Direct Downloads (Provided):

Additional Resources:

  • Search the official Air Force e-Publishing site for the latest forms.
  • Walter Reed National Military Medical Center sample version (widely used reference).
  • Templateroller or AF-Forms.com for fillable previews (for reference only; use official versions at clinics).

Note: Always use the version provided by your local Air Force dental clinic for official records. Forms may integrate into MHS GENESIS at many bases.

Tips for Air Force Dental Patients (USA)

  • Prepare Ahead — List all medications, supplements, allergies, and recent health changes.
  • Active Duty Specific — Note flying status or PRP/SCI duties if applicable.
  • Privacy — Information is protected; used only for treatment.
  • Frequency — Update at annual dental exams or when health status changes.
  • TRICARE Connection — Complements TRICARE dental benefits for families.

Proper use of AF Form 696 supports mission readiness by ensuring Airmen and families maintain optimal oral health.

Common Questions About AF Form 696

Q: Is AF Form 696 only for active duty?
A: No — it’s used for all eligible patients at Air Force dental facilities.

Q: What if my health changes after filling it out?
A: Inform your dentist at the next visit; they will update or add notes.

Q: Can I download and fill it before my appointment?
A: Yes, but confirm with your clinic, as some use digital versions.

Q: Where is it stored?
A: In your dental health record alongside treatment notes and radiographs.

For the most current guidance, visit your base dental clinic or the official Air Force e-Publishing portal. Accurate medical history ensures safe, high-quality dental care tailored to military needs.

This article is for informational purposes only and draws from official Air Force training materials and clinic references. Always consult your dental provider for personalized advice.