PDF Document Templates
Homepage >> Download DD 2870 Template
Jump Links

Misconceptions

The DD 2870 form is often misunderstood, leading to confusion among service members and their families. Here are eight common misconceptions about this important document:

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

    Many believe that only active-duty personnel need to fill out the DD 2870 form. In reality, it applies to all eligible service members, including reservists and veterans.

  2. Filling out the form is optional.

    Some think that completing the DD 2870 is a choice. However, it is often required for accessing certain benefits and services.

  3. It is a complicated form.

    While any form can seem daunting at first, the DD 2870 is straightforward. With clear instructions, most individuals can complete it without assistance.

  4. Only one copy is needed.

    Many people assume that submitting a single copy suffices. However, it is wise to keep a personal copy for your records and submit additional copies if required.

  5. It does not require a signature.

    Some believe that a signature is unnecessary. In fact, signing the form is crucial as it confirms the accuracy of the information provided.

  6. It is only relevant for medical benefits.

    While the DD 2870 is often associated with healthcare, it can also be used for other benefits, such as educational assistance.

  7. Once submitted, it cannot be changed.

    People often think that they cannot alter their information after submission. However, if changes are needed, you can contact the relevant office to update your details.

  8. It is only necessary during enrollment.

    Many think the form is needed only at the time of enrollment. In truth, it may need to be resubmitted or updated periodically to maintain eligibility for benefits.

Understanding these misconceptions can help ensure that service members and their families navigate the benefits process more effectively.

File Details

Fact Name Details
Purpose The DD Form 2870 is used to request a copy of medical records from the Department of Defense.
Who Can Use It Active duty members, veterans, and their authorized representatives can use this form.
Submission Method The form can be submitted by mail, fax, or in person to the appropriate military medical facility.
Privacy Considerations Personal information provided on the form is protected under the Privacy Act of 1974.
Required Information Individuals must provide their full name, Social Security number, and details about the records requested.
Processing Time Processing times may vary, but it typically takes several weeks to receive the requested records.
State-Specific Laws While the DD 2870 is a federal form, individual states may have additional laws regarding medical records access.
Fees There may be fees associated with copying and mailing records, depending on the facility's policies.
Additional Resources Further information can be found on the official Department of Defense website and through military medical facilities.

Key takeaways

The DD 2870 form is essential for individuals seeking to access their medical records or those of a dependent. Here are key takeaways to consider:

  • Purpose: The form is used to authorize the release of medical information from military treatment facilities.
  • Eligibility: Active duty members, veterans, and eligible dependents can fill out this form.
  • Information Required: Personal details, including full name, Social Security number, and date of birth, must be provided.
  • Signature: The form must be signed by the individual requesting the records or their legal representative.
  • Submission: Once completed, the form should be submitted to the appropriate medical facility or records office.
  • Processing Time: Expect a processing time that can vary; it may take several days to weeks to receive the requested records.
  • Privacy Considerations: Understand that the information released is protected under privacy laws, ensuring confidentiality.
  • Follow-Up: If you do not receive a response within a reasonable timeframe, follow up with the facility to check the status of your request.

Dos and Don'ts

When filling out the DD 2870 form, attention to detail is crucial. Here are some important dos and don'ts to keep in mind:

  • Do read the instructions carefully before starting.
  • Do ensure all personal information is accurate and up-to-date.
  • 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; provide all necessary information.
  • Don't use abbreviations or shorthand unless specified in the instructions.
  • Don't submit the form without reviewing it for errors.

Common mistakes

  1. Missing Signature: One of the most common mistakes is forgetting to sign the form. A signature is essential for validating the document.

  2. Incorrect Personal Information: Failing to provide accurate personal details, such as name, address, or Social Security number, can lead to delays.

  3. Inaccurate Dates: People often miswrite dates. Ensure that all dates, especially those related to service, are correct.

  4. Not Providing Required Documentation: Some sections require supporting documents. Missing these can cause the application to be incomplete.

  5. Overlooking the Privacy Act Statement: Ignoring the Privacy Act statement can lead to misunderstandings about how your information will be used.

  6. Failing to Check for Updates: Regulations can change. Not checking for the latest version of the form may result in using outdated information.

  7. Neglecting to Review the Form: Skipping a final review can mean missing errors or omissions that could affect processing.

  8. Using Incorrect Contact Information: Providing outdated or incorrect contact details can hinder communication regarding your application.

  9. Forgetting to Keep Copies: Not keeping a copy of the submitted form can lead to issues if you need to reference it later.

  10. Not Following Submission Instructions: Each form has specific submission guidelines. Failing to follow these can result in delays or rejection.

What You Should Know About This Form

  1. What is the DD 2870 form?

    The DD 2870 form is a Department of Defense document used to authorize the release of medical information. This form is primarily utilized by military personnel and their dependents to give consent for the disclosure of their health records. It ensures that medical information can be shared with designated individuals or organizations, such as healthcare providers or family members, while maintaining compliance with privacy regulations.

  2. Who needs to complete the DD 2870 form?

    Any active duty service member, reservist, or dependent seeking to share their medical information with others should complete the DD 2870 form. This includes situations where medical records need to be sent to a new healthcare provider or when a family member requires access to health information for care coordination. It is important that the person whose information is being released signs the form.

  3. How do I fill out the DD 2870 form?

    Filling out the DD 2870 form involves several steps:

    • Start by providing personal information, including your name, Social Security number, and contact details.
    • Indicate the purpose of the release, such as treatment or insurance claims.
    • Clearly list the individuals or organizations authorized to receive your medical records.
    • Sign and date the form to confirm your consent.

    Ensure that all sections are completed accurately to avoid delays in processing.

  4. Where do I submit the completed DD 2870 form?

    After completing the DD 2870 form, submit it to the appropriate medical facility or organization that holds your records. This may include military treatment facilities or civilian healthcare providers, depending on your circumstances. It is advisable to keep a copy of the completed form for your records.

DD 2870 Example

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

 

 

 

 

 

 

 

 

Consider More Forms

Florida Realtor Forms - The contract allows for specific performance or refunds in case of seller default, protecting buyer rights.

Filing the necessary paperwork is crucial for anyone looking to start a business in California, and one of the primary documents needed is the California Llc 1 form, which lays the groundwork for a Limited Liability Company. This form not only includes vital information regarding the LLC's name and address but also ensures compliance with state regulations, making it a pivotal step in the formation process.

Form 1099 Nec - Recipients use the 1099-NEC to report income on their personal tax returns.