Fill Out a Valid DD 2870 Form

The DD 2870 form is a document used by the U.S. Department of Defense to authorize the release of medical information. This form plays a crucial role in ensuring that service members and their families receive the necessary care and support. Understanding how to fill out and submit the DD 2870 can help streamline the process of accessing medical records.

Access This DD 2870 Now

The DD 2870 form plays a crucial role in the military community, particularly for those seeking medical care and benefits. Designed to facilitate the release of medical information, this form is essential for service members, veterans, and their families. It streamlines the process of obtaining necessary health records, ensuring that individuals receive timely and appropriate care. By authorizing the release of medical data, the DD 2870 allows healthcare providers to access vital information that can influence treatment decisions. Furthermore, it safeguards personal privacy while enabling efficient communication between various medical facilities. Understanding the importance of this form is key for anyone navigating the complexities of military healthcare systems. Knowing how to properly fill out and submit the DD 2870 can lead to quicker access to services and support, ultimately enhancing the well-being of those who have served our country.

Dos and Don'ts

When filling out the DD 2870 form, it is important to follow specific guidelines to ensure accuracy and compliance. Below are seven things you should and shouldn't do.

Do read the instructions carefully before starting.
Don't leave any required fields blank.
Do provide accurate and up-to-date information.
Don't use abbreviations unless specified in the instructions.
Do double-check your entries for spelling and numerical accuracy.
Don't submit the form without a signature where required.
Do keep a copy of the completed form for your records.

Following these guidelines will help ensure that your form is processed smoothly and efficiently.

Key takeaways

Filling out the DD 2870 form, which is used to authorize the release of medical information, requires careful attention to detail. Here are some key takeaways to keep in mind:

Accurate Information: Ensure that all personal details, including name, Social Security number, and contact information, are filled out accurately. Any errors may delay processing.
Signature Requirement: The form must be signed by the individual whose information is being released. If the individual is unable to sign, a legal representative must provide their signature along with appropriate documentation.
Specificity Matters: Clearly indicate what information is being requested and for what purpose. This helps in expediting the process and ensures that only relevant information is shared.
Submission Guidelines: Follow the submission instructions carefully. Depending on the purpose, the form may need to be sent to a specific department or individual. Double-check the address and method of submission.

Find Common Documents

Netspend Direct Deposit Time - Start the dispute process by filling out all required sections of this form.

Facial Waiver Form - This document serves as a record of your informed consent.

Example - DD 2870 Form

Prescribed by: DoDM 6025.18

CONTROLLED when filled

AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR DENTAL INFORMATION

PRIVACY ACT STATEMENT

In accordance with the Privacy Act of 1974 (Public Law 93-579), the notice informs you of the purpose of the form and howit will be used. Please read it carefully.

AUTHORITY: Public Law 104-191; E.O. 9397 (SSAN); DoD 6025.18-R.

PRINCIPAL PURPOSE(S): This form is to provide the Military Treatment Facility/Dental Treatment Facility/TRICARE Health Plan with a means to request the use and/or disclosure of an individual's protected health information.

ROUTINE USE(S): To any third party or the individual upon authorization for the disclosure from the individual for: personal use; insurance; continued medical care; school; legal; retirement/separation; or other reasons.

DISCLOSURE: Voluntary. Failure to sign the authorization form will result in the non-release of the protected health information.

This form will not be used for the authorization to disclose alcohol or drug abuse patient information from medical records or for authorization to disclose information from records of an alcohol or drug abuse treatment program. In addition, any use as an authorization to use or disclose psychotherapy notes may not be combined with another authorization except one to use or disclose psychotherapy notes.

SECTION I - PATIENT DATA

1. NAME (Last, First, Middle Initial)			2. DATE OF BIRTH (YYYYMMDD)		3. SOCIAL SECURITY NUMBER

4. PERIOD OF TREATMENT: FROM - TO (YYYYMMDD)			5. TYPE OF TREATMENT (X one)
			OUTPATIENT	INPATIENT		BOTH

		SECTION II -	DISCLOSURE
6. I AUTHORIZE				TO RELEASE MY PATIENT INFORMATION TO:

	(Name of Facility/TRICARE Health Plan)
a. NAME OF PERSON OR ORGANIZATION TO RECEIVE MY			b. ADDRESS (Street, City, State and ZIP Code)
MEDICAL INFORMATION			b. ADDRESS (Street, City, State and ZIP Code)
MEDICAL INFORMATION

c. TELEPHONE (Include Area Code)			d. FAX (Include Area Code)

7. REASON FOR REQUEST/USE OF MEDICAL INFORMATION (X as applicable)

PERSONAL USE

INSURANCE

CONTINUED MEDICAL CARE

RETIREMENT/SEPARATION

SCHOOL

LEGAL

OTHER (Specify)

8. INFORMATION TO BE RELEASED

9. AUTHORIZATION START DATE (YYYYMMDD)

10. AUTHORIZATION EXPIRATION

DATE (YYYYMMDD)

SECTION III - RELEASE AUTHORIZATION

ACTION COMPLETED

I understand that:

a. I have the right to revoke this authorization at any time. My revocation must be in writing and provided to the facility where my medical records are kept or to the TMA Privacy Officer if this is an authorization for information possessed by the

TRICARE Health Plan rather than an MTF or DTF. I am aware that if I later revoke this authorization, the person(s) I herein name will have used and/or disclosed my protected information on the basis of this authorization.

b. If I authorize my protected health information to be disclosed to someone who is not required to comply with federal privacy protection regulations, then such information may be re- disclosed and would no longer be protected.

c. I have a right to inspect and receive a copy of my own protected health information to be used or disclosed, in accordance with the requirements of the federal privacy protection regulations found in the Privacy Act and 45 CFR 164.524.ss

d. The Military Health System (which includes the TRICARE Health Plan) may not condition treatment in MTFs/DTFs, payment by the TRICARE Health Plan, enrollment in the TRICARE Health Plan or eligibility for TRICARE Health Plan benefits on failure to

obtain this authorization.

I request and authorize the named provider/treatment facility/TRICARE Health Plan to release the information described above to the named individual/organization indicated.

11. SIGNATURE OF PATIENT/PARENT/LEGAL REPRESENTATIVE	12. RELATIONSHIP TO PATIENT	13. DATE (YYYYMMDD)
	(If applicable)

SECTION IV - FOR STAFF USE ONLY (To be	completed only upon receipt of written revocation)

14. X IF APPLICABLE:

AUTHORIZATION REVOKED

15. REVOCATION COMPLETED BY

16.DATE (YYYYMMDD)

17. IMPRINT OF PATIENT IDENTIFICATION PLATE WHEN AVAILABLE	SPONSOR NAME:
	SPONSOR RANK:
	FMP/SPONSOR SSN:
	BRANCH OF SERVICE:
	PHONE NUMBER:

DD FORM 2870, DEC 2003
DD FORM 2870, DEC 2003		Reset
		Reset

Misconceptions

The DD 2870 form, also known as the "Authorization for Disclosure of Medical or Dental Information," is often misunderstood. Here are ten common misconceptions about this important document:

It’s only for active duty military members. Many believe that only active duty personnel need to fill out the DD 2870. In reality, veterans and their dependents may also need to use this form to authorize the release of their medical or dental records.
It can only be used for medical records. While the form is primarily associated with medical records, it can also be used to authorize the release of dental information. This is crucial for those seeking comprehensive care.
Filling it out is optional. Some individuals think that completing the DD 2870 is a choice. However, if you want your medical or dental records shared with a specific provider or facility, submitting this form is necessary.
It doesn’t require a signature. A common misconception is that the form can be submitted without a signature. In fact, a valid signature is essential to ensure that the authorization is legitimate and binding.
Once submitted, it can’t be revoked. Many people believe that once they submit the DD 2870, they lose control over their information. However, you can revoke your authorization at any time, provided you do so in writing.
It’s the same as other medical release forms. Some may think that the DD 2870 is interchangeable with other medical release forms. However, it has specific requirements and is tailored for military-related health records.
It’s only needed for emergencies. There’s a misconception that the DD 2870 is only necessary during medical emergencies. In truth, it’s often required for routine care or when transferring records to new healthcare providers.
It can be filled out by anyone. Some individuals assume that anyone can complete the DD 2870 on behalf of a service member or veteran. Only the individual whose records are being requested or their legal representative can authorize the release.
It takes a long time to process. Many fear that submitting the DD 2870 will lead to lengthy delays. While processing times can vary, most requests are handled efficiently, especially when all required information is provided.
It’s not important for future healthcare. Some may underestimate the significance of the DD 2870 for their ongoing healthcare. However, having access to your medical and dental records is vital for continuity of care and informed treatment decisions.

Understanding these misconceptions can help you navigate the process of obtaining and sharing medical and dental information more effectively. Don't let confusion hinder your access to essential healthcare services.

Similar forms

The DD 2870 form is a request for medical records and information, often used within military and veteran contexts. Several other documents serve similar purposes in different scenarios. Here’s a list of seven documents that share similarities with the DD 2870 form:

VA Form 21-4142: This form is used by veterans to authorize the release of their medical records to the Department of Veterans Affairs. Like the DD 2870, it ensures that personal health information is shared appropriately.
HIPAA Release Form: This document allows individuals to give consent for healthcare providers to share their medical information with third parties. Similar to the DD 2870, it protects patient privacy while facilitating access to necessary records.
SF 180: The Standard Form 180 is used to request military records, including discharge papers and medical records. It parallels the DD 2870 in its purpose of obtaining vital information for veterans.
VA Form 10-5345: This form is specifically for veterans to request the release of their medical records from VA facilities. It serves a similar function as the DD 2870, focusing on accessing health information.
Form 5-455: This form is used in various healthcare settings to request medical records. Like the DD 2870, it is essential for ensuring that individuals can obtain their medical history when needed.
Patient Authorization for Release of Information: This document allows patients to authorize healthcare providers to disclose their medical information. It shares the same goal as the DD 2870, ensuring that patients control who accesses their records.
Medicare Authorization Form: This form is used by Medicare beneficiaries to authorize the release of their medical records to Medicare or other healthcare providers. It functions similarly to the DD 2870 by facilitating access to health information.