What is DD Form 2870?
Form DD 2870, Authorization for Disclosure of Medical or Dental Information, is essential for patients within military treatment facilities and TRICARE health plans. This form grants permission to share personal medical or dental information, ensuring that only authorized individuals have access to sensitive health details. By completing this form, patients maintain control over who can view their medical records, which is particularly crucial in military healthcare environments where privacy is a top priority.
What is DD Form 2870 used for?
DD Form 2870 is essential for managing your medical information. Here's what it’s used for:
- Authorizes the release of your health information for personal use, insurance, continued medical care, school, legal matters, or retirement/separation.
- Allows military treatment facilities, dental treatment facilities, or TRICARE Health Plan to request and share your medical or dental information.
How to fill out DD Form 2870?
- 1
Complete blocks 1 and 2 with the patient's name and date of birth.
- 2
Fill in block 3 with the sponsor's SSN.
- 3
Indicate the dates of treatment in block 4 or mark "ALL TIME PERIODS."
- 4
Specify whether you are requesting outpatient or inpatient records in block 5.
- 5
Provide reasons for the request and specify the party for disclosure in the authorization section.
- 6
Include the authorization start and expiration dates, ensuring all blocks are fully completed.
Who is required to fill out DD Form 2870?
TRICARE beneficiaries, including military personnel, retirees, and their dependents, are responsible for completing DD Form 2870. Additionally, parents or legal representatives of minors may also fill out this form.
After completion, healthcare providers or contractors use the form to obtain consent to share a patient's protected health information with third parties for various purposes, including insurance and continued medical care.
When is DD Form 2870 not required?
DD Form 2870 isn’t needed when authorizing the disclosure of substance abuse information or treatment from medical records. It also isn’t required for authorizing the use or disclosure of psychotherapy notes if combined with another authorization. Additionally, it does not apply to disclosures that do not need to comply with federal privacy protection regulations.
When is DD Form 2870 due?
The deadline for DD Form 2870 is when you need to authorize the release of your medical or dental information. It is recommended to request this information at least three months after completing the form. However, any date can be used. Remember, the form must be signed and dated by you or your representative.
How to get a blank DD Form 2870?
To get a blank DD Form 2870, simply visit our website. The form is issued by the Department of Defense and managed by the Defense Health Agency. Our platform has a pre-loaded version ready for you to fill out and download. Remember, we assist with filling and downloading but not filing forms.
How to sign DD Form 2870 online?
To sign Form DD 2870, Authorization for Disclosure of Medical or Dental Information, you must use a handwritten signature, as electronic or digital signatures are not accepted. After filling out the form using PDF Guru, you can download it for your records. Remember to check for any updates or changes to the form before submitting it elsewhere, as PDF Guru does not support submission.
Where to file DD Form 2870?
To submit Form DD 2870, print the completed form and gather a copy of your military ID or state driver's license.
Mail the hard copy original and ID to Fox Army Health Center. Remember, this form cannot be submitted online.
