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The DD 2870 form plays a crucial role in the military and veteran community, serving as a vital tool for those seeking to access their medical records and other related benefits. Designed to streamline the process of obtaining health care services, this form is essential for service members, veterans, and eligible dependents who require medical treatment through the Department of Defense. By filling out the DD 2870, individuals can authorize the release of their medical information, ensuring they receive the care they need in a timely manner. This form not only facilitates communication between healthcare providers but also protects the privacy of the individuals involved. Understanding the ins and outs of the DD 2870 is key for anyone navigating the complexities of military healthcare. Whether you’re a service member or a family member, knowing how to properly complete and submit this form can make a significant difference in accessing the benefits you deserve.

Dos and Don'ts

When filling out the DD 2870 form, it's important to approach the task with care. Here are some essential dos and don’ts to keep in mind:

  • Do read the instructions thoroughly before starting. Understanding the requirements can save you time and prevent mistakes.
  • Do provide accurate and complete information. Double-check your entries to ensure everything is correct.
  • Do sign and date the form where indicated. An unsigned form may be considered incomplete.
  • Do keep a copy of the completed form for your records. This can be helpful for future reference.
  • Don't rush through the form. Taking your time helps avoid errors that could delay processing.
  • Don't leave any required fields blank. If a question does not apply, write "N/A" instead.
  • Don't forget to check for any additional documents that may need to accompany the form. Missing paperwork can slow things down.
  • Don't hesitate to ask for help if you’re unsure about any part of the form. Seeking assistance can clarify doubts and ensure accuracy.

Document Attributes

Fact Name Details
Purpose The DD Form 2870 is used to authorize the release of medical information.
Applicable Entities This form is typically utilized by military personnel and their dependents.
Privacy Act Compliance The form complies with the Privacy Act of 1974, ensuring confidentiality of medical records.
Signature Requirement A signature is required from the individual whose information is being released.
Expiration The authorization remains valid until revoked or until a specified expiration date.
State-Specific Variations Some states may have their own forms, governed by state laws such as HIPAA regulations.
Distribution The completed form should be submitted to the relevant medical facility or provider.
Accessibility The DD Form 2870 is available online through official military and government websites.

Key takeaways

The DD 2870 form is essential for individuals seeking to authorize the release of their medical records. Here are key takeaways to consider when filling out and using this form:

  • The form is officially titled "Authorization for Disclosure of Medical or Dental Information."
  • It is primarily used by military personnel and veterans to access their health records.
  • Accurate completion of the form is crucial to ensure timely processing of requests.
  • All required fields must be filled out, including personal information and the specific records requested.
  • Signatures are necessary; both the patient and the authorized representative must sign where applicable.
  • Keep a copy of the completed form for your records after submission.
  • Submit the form to the appropriate medical facility or records office as indicated in the instructions.
  • Be aware that processing times may vary depending on the facility and the volume of requests.

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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

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

Reset

 

 

 

 

 

 

 

 

Detailed Instructions for Writing DD 2870

Filling out the DD 2870 form is a straightforward process. Once you complete it, you can submit it as required. Follow these steps carefully to ensure everything is filled out correctly.

  1. Begin by downloading the DD 2870 form from the official website or obtaining a hard copy.
  2. Read the instructions on the form to understand what information is needed.
  3. Fill in your personal information at the top, including your full name, Social Security number, and contact details.
  4. Provide information about your military service, including your branch and service dates.
  5. Complete the section that asks for details about the benefits or services you are requesting.
  6. Sign and date the form at the designated area to certify that the information is true.
  7. Review the entire form to ensure all sections are completed accurately.
  8. Make a copy of the completed form for your records.
  9. Submit the form according to the instructions provided, either by mail or electronically, as required.

Documents used along the form

The DD 2870 form is primarily used to request a copy of military records. It is often accompanied by several other forms and documents that support the request or are necessary for various administrative processes. Below is a list of commonly used documents that may be relevant when submitting the DD 2870 form.

  • DD Form 214: This document provides a summary of a service member's military service, including discharge status, and is essential for many benefits and services.
  • SF 180: The Standard Form 180 is used to request military records and can serve as an alternative to the DD 2870 form.
  • Durable Power of Attorney: A Texas Durable Power of Attorney form is essential for designating an agent to manage financial and legal decisions on behalf of the principal, particularly useful in times of incapacity. For more details, you can refer to Texas Forms Online.
  • VA Form 21-526EZ: This form is used to apply for veterans' disability compensation and often requires supporting military records.
  • VA Form 21-4138: Known as the Statement in Support of Claim, this form allows veterans to provide additional information to support their claims.
  • DD Form 2656: This form is used to apply for retirement pay and may require documentation of service history.
  • SF 15: The Application for 10-Point Veteran Preference is used by veterans seeking preference in federal hiring, often necessitating proof of military service.
  • VA Form 22-1990: This form is used for applying for education benefits and may require verification of military service.
  • DD Form 137-3: This form is used to apply for a dependent's ID card and requires proof of military service.
  • VA Form 21-530: The Application for Burial Benefits is used by veterans' families to request burial benefits and often requires military service documentation.

Understanding these documents can help streamline the process when requesting military records or benefits. Each form plays a crucial role in ensuring that veterans and their families receive the support they need. Be sure to review the requirements for each document carefully to ensure a complete and accurate submission.