The DD 2870 form is a crucial document used by military personnel and their families to authorize the release of medical information. This form ensures that health care providers can share necessary medical records with designated individuals, facilitating better communication and care. Understanding how to properly complete and submit the DD 2870 can streamline the process of accessing vital health information.
The DD 2870 form plays a crucial role in the military and veteran communities, serving as a vital tool for individuals seeking to access specific benefits and services. This form is primarily used to authorize the release of medical information, ensuring that service members and veterans can receive the necessary healthcare support. It is essential for those applying for benefits through the Department of Veterans Affairs (VA) or other military-related healthcare programs. By completing the DD 2870, individuals grant permission for healthcare providers to share their medical records, which can facilitate smoother processing of claims and benefits. Additionally, understanding the nuances of this form can significantly impact the timeliness and effectiveness of accessing the benefits owed to service members and their families. The form must be filled out accurately and submitted through the appropriate channels to ensure compliance with privacy regulations while expediting the healthcare process. Knowing how to navigate the DD 2870 can empower veterans and active-duty personnel to take charge of their health and benefits, ultimately leading to better outcomes.
What is the DD 2870 form?
The DD 2870 form, also known as the "Authorization for Disclosure of Medical or Dental Information," is a document used by military service members and their dependents. This form allows individuals to authorize the release of their medical or dental records to specific parties, such as healthcare providers or insurance companies. It ensures that personal health information can be shared appropriately while maintaining privacy and confidentiality.
Who needs to fill out the DD 2870 form?
Any active duty service member, reservist, or dependent who requires their medical or dental records to be shared with another party should complete the DD 2870 form. This may include situations where a service member is seeking treatment from a civilian healthcare provider or when insurance claims require documentation of prior medical care. It is essential for ensuring that the necessary parties have access to vital health information.
How do I submit the DD 2870 form once it is completed?
After filling out the DD 2870 form, you should submit it to the appropriate medical or dental facility where your records are held. This may be a military treatment facility or a civilian provider, depending on your circumstances. Make sure to keep a copy for your records. If you're unsure where to send it, contacting the facility directly for guidance can be helpful.
Are there any specific requirements for completing the DD 2870 form?
When filling out and using the DD 2870 form, keep these key points in mind:
The DD 2870 form is often misunderstood. Here are eight common misconceptions about it:
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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Incorrect Personal Information: One common mistake is providing inaccurate personal details. This can include misspellings of names, wrong Social Security numbers, or incorrect addresses. Always double-check your information before submitting.
Missing Signatures: Many people forget to sign the form. A missing signature can delay processing. Ensure that all required signatures are present, including those of witnesses if necessary.
Not Providing Supporting Documents: Failing to include necessary documentation is another frequent error. Depending on the purpose of the form, you may need to attach additional papers. Make a checklist of required documents to avoid this issue.
Ignoring Instructions: Each form comes with specific instructions. Skipping these can lead to mistakes. Take the time to read through all guidelines carefully to ensure compliance with the requirements.
When filling out the DD 2870 form, it’s important to follow specific guidelines to ensure accuracy and compliance. Here’s a list of what you should and shouldn’t do:
The DD 214 form is a critical document for veterans, serving as proof of military service. It provides details such as the service member's dates of active duty, discharge status, and type of service. Like the DD 2870, which is used to authorize the release of medical records, the DD 214 also requires the service member's consent to disclose personal information. Both forms are essential for accessing benefits and services related to military service.
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The SF 180 form is another important document for veterans seeking to obtain their military records. This form allows individuals to request copies of their military service records from the National Archives. Similar to the DD 2870, the SF 180 requires the requester to provide personal information and a signature, ensuring that only authorized individuals can access sensitive records.
The VA Form 21-526EZ is used by veterans to apply for disability compensation. This form requires detailed information about the veteran’s service and any disabilities incurred. Like the DD 2870, it necessitates the veteran’s consent to review medical records, ensuring that the Department of Veterans Affairs can verify claims effectively.
The VA Form 10-5345 is a request for the release of medical records from the VA. This form is similar to the DD 2870 in that it authorizes the release of health information. Both forms protect the privacy of the individual while allowing for necessary disclosures to facilitate care or benefits.
The DD Form 149 is a request for correction of military records. This document allows service members and veterans to seek changes to their records, such as correcting errors. Like the DD 2870, the DD Form 149 requires the individual’s signature, ensuring that changes are made only with the proper authorization.
The VA Form 21-4142 is used to authorize the release of information from non-VA healthcare providers. This form is similar to the DD 2870 in that it facilitates the sharing of medical information. Both forms aim to ensure that veterans receive comprehensive care by allowing access to relevant health records.
The DD Form 1172-2 is used to apply for a military ID card and requires personal information from the applicant. This form is similar to the DD 2870 because it also requires verification of identity and consent for the use of personal information. Both forms are essential for accessing military benefits and services.
The Form SF 86 is used for background investigations for security clearance. This form requires detailed personal information and consent for background checks. Like the DD 2870, it emphasizes the importance of protecting sensitive information while allowing necessary disclosures for security purposes.