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The DD 2870 form plays a crucial role in the military community, serving as a request for medical and dental records. This form is essential for service members, veterans, and their families who need to access their health information for various purposes, including treatment continuity and benefits eligibility. By filling out the DD 2870, individuals can authorize the release of their medical records from the Department of Defense or other relevant healthcare providers. The process is designed to ensure that personal health information is handled securely and in compliance with privacy regulations. Completing the form accurately is vital, as it helps prevent delays in receiving necessary medical care or benefits. Understanding the importance of this form can help service members navigate their healthcare needs more effectively.
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Steps to Using DD 2870
After you have gathered the necessary information and documents, you can begin filling out the DD 2870 form. This process involves providing specific details about yourself and your request. Follow these steps carefully to ensure that your form is completed correctly.
- Start by downloading the DD 2870 form from the official military or government website.
- Print the form or fill it out electronically if the option is available.
- In the first section, enter your personal information. This includes your name, address, and contact details.
- Provide your Social Security number or other identification number as required.
- Indicate your relationship to the service member if applicable.
- Fill in the details regarding the specific request you are making. Be clear and concise.
- Review the form for any errors or missing information.
- Sign and date the form at the designated area.
- Make a copy of the completed form for your records.
- Submit the form according to the instructions provided, whether by mail or electronically.
Key takeaways
The DD 2870 form is crucial for individuals seeking to authorize the release of their medical records. Here are some key takeaways to consider:
- Understand the Purpose: The form is used to grant permission for healthcare providers to share medical information.
- Eligibility: Anyone seeking treatment or involved in a legal matter may need to fill out this form.
- Complete All Sections: Ensure that every part of the form is filled out accurately to avoid delays.
- Signature Required: The individual requesting the release must sign the form to validate it.
- Specify Information: Clearly indicate what specific medical records you want released.
- Time Limit: Be aware that the authorization may have an expiration date; check the form for details.
- Revocation: You can revoke the authorization at any time, but it must be done in writing.
- Submit Correctly: Send the completed form to the appropriate healthcare provider or agency.
- Keep Copies: Retain a copy of the signed form for your records.
- Consult If Needed: If unsure about any part of the form, seek assistance from a legal professional or healthcare provider.
Misconceptions
The DD 2870 form is an important document used in various military and veteran contexts. However, there are several misconceptions surrounding it. Here are four common misunderstandings:
- Misconception 1: The DD 2870 form is only for active-duty service members.
- Misconception 2: Completing the DD 2870 form guarantees access to all requested records.
- Misconception 3: The DD 2870 form is only necessary for medical records.
- Misconception 4: Submitting the DD 2870 form is a complicated process.
This is not true. The DD 2870 form can also be used by veterans and eligible family members. It serves as a request for medical records and other health information, regardless of the individual's current status in the military.
While the form is a request for records, it does not guarantee that all requested information will be provided. Access to certain records may be restricted due to privacy laws or other regulations.
This form can be used for various types of information requests, not just medical records. It may also apply to other documents related to military service, benefits, or eligibility.
In reality, the process is designed to be straightforward. Individuals can often complete the form online or through their healthcare provider, making it accessible for those who need it.
Preview - 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
AUTHORITY: Public Law
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
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) |
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2. DATE OF BIRTH (YYYYMMDD) |
3. SOCIAL SECURITY NUMBER |
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4. PERIOD OF TREATMENT: FROM - TO (YYYYMMDD) |
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5. TYPE OF TREATMENT (X one) |
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OUTPATIENT |
INPATIENT |
BOTH |
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SECTION II - |
DISCLOSURE |
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6. I AUTHORIZE |
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TO RELEASE MY PATIENT INFORMATION TO: |
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(Name of Facility/TRICARE Health Plan) |
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a. NAME OF PERSON OR ORGANIZATION TO RECEIVE MY |
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b. ADDRESS (Street, City, State and ZIP Code) |
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MEDICAL INFORMATION |
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c. TELEPHONE (Include Area Code) |
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d. FAX (Include Area Code) |
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7. REASON FOR REQUEST/USE OF MEDICAL INFORMATION (X as applicable) |
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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) |
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(If applicable) |
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SECTION IV - FOR STAFF USE ONLY (To be |
completed only upon receipt of written revocation) |
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14. X IF APPLICABLE:
AUTHORIZATION REVOKED
15. REVOCATION COMPLETED BY
16.DATE (YYYYMMDD)
17. IMPRINT OF PATIENT IDENTIFICATION PLATE WHEN AVAILABLE |
SPONSOR NAME: |
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SPONSOR RANK: |
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FMP/SPONSOR SSN: |
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BRANCH OF SERVICE: |
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PHONE NUMBER: |
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DD FORM 2870, DEC 2003 |
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Document Specs
| Fact Name | Description |
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| Purpose | The DD Form 2870 is used to authorize the release of medical information for military personnel and their dependents. |
| Usage | This form is commonly used by healthcare providers to obtain consent before sharing a patient’s medical records. |
| Eligibility | Any active duty service member, veteran, or eligible dependent can use this form to authorize the release of their medical information. |
| Governing Law | The use of this form is governed by the Health Insurance Portability and Accountability Act (HIPAA) as well as Department of Defense regulations. |
| Confidentiality | Information released using this form is protected and must be handled in accordance with privacy laws. |
| Completion | The form must be filled out completely and signed by the individual granting authorization for the release of their medical information. |
| Expiration | Authorization granted through this form does not last indefinitely; it typically expires after a specified period unless stated otherwise. |
| Submission | The completed DD Form 2870 should be submitted to the appropriate medical facility or healthcare provider to initiate the release process. |