The DD 2870 form is a request for medical records or health information from the Department of Defense. This form is essential for service members and veterans seeking access to their medical history. To get started on obtaining your records, fill out the DD 2870 by clicking the button below.
The DD 2870 form, also known as the "Authorization for Disclosure of Medical or Dental Information," is often misunderstood. Below are ten common misconceptions about this form, along with clarifications for each.
Understanding these misconceptions can help individuals navigate the process of obtaining medical and dental records more effectively.
The DD 2870 form is an essential document used by military personnel and their families to authorize the release of medical information. When dealing with medical records and related processes, several other forms and documents may come into play. Understanding these documents can help streamline the process and ensure that all necessary information is provided.
Each of these forms serves a distinct purpose and can be crucial in different scenarios involving military personnel and their families. Familiarity with these documents can help ensure that all necessary steps are taken when accessing benefits and services.
Filling out the DD 2870 form can be a straightforward process, but many people make common mistakes that can lead to delays or complications. One frequent error is not providing complete personal information. It is crucial to fill in all required fields, including full name, social security number, and contact information. Omitting even a single detail can result in processing issues.
Another mistake occurs when individuals fail to read the instructions carefully. Each section of the form has specific requirements. Ignoring these guidelines can lead to incorrect submissions. Take the time to review the instructions thoroughly before starting the form. This can save time and prevent frustration later.
People often misinterpret the eligibility criteria outlined in the form. It is important to ensure that you meet all necessary qualifications before applying. Misunderstanding these requirements can lead to unnecessary applications and wasted effort. If in doubt, seek clarification before proceeding.
Additionally, many individuals neglect to double-check their entries for accuracy. Simple typos or incorrect information can cause significant delays. A quick review can help catch errors before submission. Consider having someone else look over the form as well; a fresh set of eyes can spot mistakes that may have been overlooked.
Lastly, failing to submit the form on time is a common issue. Each application has deadlines that must be adhered to. Mark important dates on your calendar and ensure that you submit the form well in advance. Procrastination can lead to missed opportunities, so stay organized and proactive.
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
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