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Homepage Fill Out a Valid DD 2870 Template

Form Specs

Fact Name Description
Purpose The DD Form 2870 is used to request a copy of a service member's medical records from the Department of Defense.
Eligibility Active duty, reserve, and retired service members, as well as their authorized family members, can use this form to access their medical information.
Submission Process The completed form must be submitted to the appropriate military medical facility or the National Personnel Records Center for processing.
Governing Law The form is governed by the Privacy Act of 1974, which protects personal information held by federal agencies.

Dos and Don'ts

When filling out the DD 2870 form, it is important to follow certain guidelines to ensure accuracy and completeness. Below are five things to do and not do during this process.

  • Do read the instructions carefully before starting to fill out the form.
  • Do provide accurate and up-to-date information.
  • Do double-check your entries for any errors or omissions.
  • Do sign and date the form where required.
  • Do keep a copy of the completed form for your records.
  • Don't leave any required fields blank.
  • Don't use abbreviations or shorthand that may cause confusion.
  • Don't submit the form without reviewing it thoroughly.
  • Don't provide false or misleading information.
  • Don't forget to check the submission method and address for the completed form.

Common mistakes

  1. Incomplete Information: Many individuals fail to fill out all required fields. Every section must be completed to avoid delays.

  2. Incorrect Personal Details: Providing inaccurate names, addresses, or Social Security numbers can lead to processing errors.

  3. Missing Signatures: Some people forget to sign the form. A signature is crucial for the form to be valid.

  4. Improper Date Format: Using the wrong date format can cause confusion. Stick to the format specified on the form.

  5. Omitting Supporting Documents: Failing to include necessary documentation can result in rejection. Always double-check what is needed.

  6. Not Keeping Copies: It’s important to keep a copy of the submitted form for your records. This can be useful for future reference.

  7. Ignoring Instructions: Skipping the instructions can lead to critical mistakes. Always read the guidelines carefully before filling out the form.

  8. Submitting Late: Missing deadlines can affect eligibility. Be aware of submission timelines and plan accordingly.

  9. Using Inappropriate Ink: Some forms specify the type of ink to use. Using the wrong ink can cause issues during processing.

Documents used along the form

The DD 2870 form is a vital document used primarily for obtaining access to medical records and information in military settings. However, several other forms and documents are often used in conjunction with it. Understanding these additional documents can help streamline the process and ensure that all necessary information is gathered efficiently.

  • DD Form 214: This form is known as the Certificate of Release or Discharge from Active Duty. It provides a summary of a service member's military service, including dates of service, discharge status, and awards received. It is essential for veterans seeking benefits.
  • SF 180: The Standard Form 180 is used to request military records from the National Archives. It allows veterans and next-of-kin to obtain copies of service records, which may be necessary for various applications, including benefits and claims.
  • VA Form 21-526EZ: This form is used to apply for disability compensation from the Department of Veterans Affairs. It requires information about the veteran's service and any disabilities incurred during service, making it crucial for those seeking financial support.
  • California LLC-1 Form: This submission cover sheet is vital for filing Articles of Organization for a Limited Liability Company in California and can be accessed at californiadocsonline.com/california-llc-1-form.
  • DD Form 2875: This form is the System Authorization Access Request. It is necessary for individuals seeking access to certain Department of Defense systems, including those that may contain medical records or other sensitive information.
  • VA Form 10-5345: The Request for and Authorization to Release Medical Records or Health Information form is used to authorize the release of medical records from VA facilities. This document is essential for obtaining health information when applying for benefits.
  • DD Form 149: This form is used to apply for a correction of military records. If there are discrepancies in a service member's records, this form can initiate the process to amend those records.
  • VA Form 21-4142: This is the Authorization and Consent to Release Information to the Department of Veterans Affairs form. It allows the VA to obtain medical records from non-VA healthcare providers, which may be necessary for processing claims.

Each of these forms plays a crucial role in the process of accessing military records, applying for benefits, or correcting service-related information. Being familiar with these documents can facilitate smoother interactions with military and veteran services, ensuring that individuals receive the support and resources they need.

Misconceptions

The DD 2870 form is often misunderstood. Here are eight common misconceptions:

  1. It is only for active-duty military members.

    Many believe that only active-duty personnel need to fill out the DD 2870 form. In reality, this form can be used by veterans and their dependents as well.

  2. It is only required for medical records.

    Some think the DD 2870 is solely for accessing medical records. However, it can also be used for other types of information, including service records.

  3. Filling it out is optional.

    While some may view the DD 2870 as optional, it is often a necessary step to obtain vital information, especially when dealing with benefits.

  4. It can be submitted online only.

    There is a misconception that the form must be submitted online. You can also submit it via mail or in person, depending on your needs.

  5. It takes a long time to process.

    Many assume that processing the DD 2870 takes weeks. In many cases, it can be processed much faster, depending on the request and the office handling it.

  6. It is the same as other forms.

    Some people think the DD 2870 is interchangeable with other forms. Each form serves a specific purpose, and using the correct one is crucial for your request.

  7. Only one form is needed for multiple requests.

    Individuals may believe they can use one DD 2870 for multiple requests. In fact, separate forms may be required for different types of information.

  8. It can be filled out incorrectly without consequences.

    There is a belief that errors on the DD 2870 won’t matter. However, incorrect information can delay processing or lead to denied requests.

Understanding these misconceptions can help ensure that the form is completed correctly and submitted in a timely manner.

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 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

 

 

 

 

 

 

 

 

Key takeaways

When filling out and using the DD 2870 form, keep these key takeaways in mind:

  • Understand the Purpose: The DD 2870 form is used to authorize the release of medical information. It's essential for obtaining your health records from the military.
  • Complete All Sections: Ensure every section of the form is filled out accurately. Missing information can delay the processing of your request.
  • Provide Identification: Include a copy of your identification. This helps verify your identity and ensures that your records are released to the correct person.
  • Check Submission Guidelines: Be aware of where and how to submit the form. Different facilities may have specific instructions for processing requests.
  • Follow Up: After submitting the form, follow up if you do not receive a response within a reasonable time. This can help ensure your request is being processed.

Similar forms

The DD 2870 form is a request for the release of medical records and information. It serves a specific purpose within the military and veteran community. Below are seven documents that are similar to the DD 2870 form, each serving a unique but related function.

  • VA Form 21-4142: This form is used by veterans to authorize the release of their medical information to the Department of Veterans Affairs. Like the DD 2870, it facilitates access to essential health records.
  • HIPAA Authorization Form: This document allows individuals to give permission for healthcare providers to share their medical information with third parties. Both forms ensure that personal health information is disclosed appropriately.
  • SF 180: The Standard Form 180 is used to request military records. Similar to the DD 2870, it helps individuals obtain necessary documentation for benefits or personal use.
  • VA Form 21-526EZ: This form is for applying for disability compensation and requires medical records to support the claim. It parallels the DD 2870 in the need for access to medical information.
  • Illinois 20A Form (Notice to Appear): This form is crucial for legal proceedings in Will County, requiring defendants to be notified to appear in court regarding real estate possession; for more information, visit formsillinois.com.
  • DD Form 214: This document provides proof of military service and may require medical records for verification in certain cases. Both forms are integral to accessing veteran benefits.
  • VA Form 21-4192: This form is used to request employment information from former employers. It may require medical records to substantiate claims, similar to the DD 2870's purpose.
  • VA Form 10-5345: This form is specifically for veterans to authorize the release of their medical records from VA facilities. It shares the same goal of facilitating access to health information as the DD 2870.