What is Form DD-2870?
Form DD-2870 is a crucial document for TRICARE beneficiaries, allowing them to authorize the release of their medical or dental information to designated individuals or organizations. This form empowers beneficiaries to manage access to their health records, which is especially important for minors under 18, ensuring that parents or guardians can obtain necessary information for purposes like personal use, insurance claims, or ongoing medical care. Without this authorization, patient information remains confidential, safeguarding privacy and security.
What is Form DD-2870 used for?
Form DD-2870 is essential for managing your health information. It allows you to grant permission for others to access your medical or dental records. Here’s what it’s used for:
- Authorization for Disclosure: Allows a patient to permit the release of their health information.
- Patient Data Collection: Gathers essential details like name, date of birth, and social security number.
- Treatment Information: Specifies what treatment details can be shared and for how long.
- Disclosure to Third Parties: Enables sharing information for various purposes, including personal use, insurance, or legal needs.
How to fill out Form DD-2870?
- 1
Fill in the patient's name in Block 1 and date of birth in Block 2.
- 2
Enter the sponsor's SSN or DoD ID number in Block 3.
- 3
Specify treatment dates or select "ALL TIME PERIODS" in Block 4.
- 4
Mark the type of information requested in Block 5.
- 5
Provide the recipient's name, mailing address, and phone number in Blocks 6a, 6b, and 6c.
- 6
Set the authorization start date in Block 9 and expiration date in Block 10.
Who is required to fill out Form DD-2870?
Patients, parents, or legal representatives are responsible for completing Form DD-2870 to authorize the use and disclosure of protected health information. After completion, military treatment facilities and dental treatment facilities use the form to request and share medical or dental information for various purposes, including personal use and legal proceedings.
When is Form DD-2870 not required?
You don't need to file Form DD-2870 if you’re not seeking medical or dental treatment from a military treatment facility or Department of Defense health plan. Eligible beneficiaries enrolled in a Uniformed Services Family Health Plan also don’t require this form for routine care. Additionally, it doesn’t authorize the disclosure of substance abuse information or psychotherapy notes.
When is Form DD-2870 due?
The deadline for Form DD-2870 is when you need to authorize the release of your medical or dental information. Typically, you should request this information at least three months from when you complete the form. However, you can choose any date. Remember, the form must be signed and dated by you or your representative.
How to get a blank Form DD-2870?
To get a blank Form DD-2870, simply visit our platform. This form is issued by the Department of Defense and managed by the Defense Health Agency. Our website has a pre-loaded version ready for you to fill out. Remember, we help with filling and downloading forms, but not filing them.
How to sign Form DD-2870 online?
To sign Form DD-2870 online, first fill out the necessary fields using PDF Guru. Once you've completed the form, create a simple electronic signature if the form accepts it. Remember, PDF Guru allows you to download the filled form for your records, but it does not support submission or digital signatures. Always check for the latest updates on signing requirements to ensure compliance.
Where to file Form DD-2870?
To submit Form DD-2870, you can choose to email or mail it. For email submission, send the completed form to the designated Navy Medicine Records Activity email address.
If you opt for mailing, address the form to the Navy Medicine Records Activity at the Robert A Young Federal Building in St. Louis, MO. Alternatively, you can fax your request along with a copy of your ID to the provided fax number.
