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Overview

Common mistakes

  1. Incomplete Information: Many individuals fail to fill out all required fields. This can lead to delays in processing. Ensure every section is completed accurately.

  2. Incorrect Signatures: Some people neglect to sign the form or provide the wrong signature. Always verify that the signature matches the name provided on the form.

  3. Missing Supporting Documents: Applicants often forget to attach necessary documentation. Review the checklist to confirm all required documents are included.

  4. Failure to Update Information: Individuals may use outdated personal information. Check that your contact details and other information are current before submission.

  5. Not Following Submission Instructions: Some fail to adhere to the specific submission guidelines. Carefully read the instructions to ensure the form is sent to the correct address.

Similar forms

  • SF 180 - Request Pertaining to Military Records: This form is used to request access to an individual's military service records. Similar to the DD 2870, it requires specific personal information to verify identity.
  • VA Form 21-526EZ - Application for Disability Compensation and Related Compensation Benefits: This application seeks to obtain benefits for veterans. Like the DD 2870, it necessitates detailed personal information and documentation to support claims.
  • DD Form 214 - Certificate of Release or Discharge from Active Duty: This document provides proof of military service and is often required for various benefits. It parallels the DD 2870 in its focus on military service verification.
  • SF 86 - Questionnaire for National Security Positions: This form is utilized for background checks for security clearance. Similar to the DD 2870, it collects extensive personal data to assess eligibility.
  • Form 990 - Return of Organization Exempt from Income Tax: Nonprofit organizations use this form to report financial information. Like the DD 2870, it requires detailed data to ensure compliance and transparency.
  • Form I-9 - Employment Eligibility Verification: This form is required to verify the identity and employment authorization of individuals. It shares the DD 2870's purpose of collecting personal information for verification.
  • Georgia Deed Form: This legal document is essential for transferring property ownership in Georgia, ensuring clarity in transactions. For more information, you can visit georgiaform.com.
  • Form W-4 - Employee's Withholding Certificate: Employees submit this form to determine tax withholding. Both the W-4 and DD 2870 require personal information to process requests accurately.
  • Form 1099 - Miscellaneous Income: This form reports various types of income other than wages. Like the DD 2870, it necessitates accurate information for proper tax reporting.
  • Form 4506-T - Request for Transcript of Tax Return: Individuals use this form to request tax return transcripts from the IRS. Similar to the DD 2870, it requires personal data for identity verification.
  • Form 3500 - Application for Registration of a Medical Corporation: This form is used for registering medical corporations in certain states. It, too, requires detailed information about the entity, similar to the DD 2870's information requirements.

Dos and Don'ts

When filling out the DD 2870 form, it is important to follow certain guidelines to ensure accuracy and completeness. Here are seven things you should and shouldn't do:

  • Do read the instructions carefully before starting the form.
  • Do provide accurate and up-to-date information.
  • Do double-check your entries for any errors or omissions.
  • Do sign and date the form where required.
  • Don't leave any required fields blank.
  • Don't use abbreviations unless specified in the instructions.
  • Don't submit the form without reviewing it thoroughly.

Preview - DD 2870 Form

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

 

 

 

 

 

 

 

 

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Misconceptions

The DD 2870 form is often misunderstood. Here are some common misconceptions about this form, along with clarifications to help clear up any confusion.

  • Misconception 1: The DD 2870 form is only for military personnel.

    • This form is actually used by both military members and their eligible family members for healthcare services. It is not limited to just active-duty service members.

  • Misconception 2: Completing the DD 2870 form guarantees approval for healthcare services.

    • While the form is necessary to initiate the process, it does not ensure that all requests will be approved. Approval is subject to eligibility and specific healthcare policies.

  • Misconception 3: The DD 2870 form can be submitted at any time without deadlines.

    • There are specific timelines associated with submitting this form, especially for certain types of healthcare services. It's important to be aware of these deadlines to avoid complications.

  • Misconception 4: You can submit the DD 2870 form electronically only.

    • While electronic submission is an option, the form can also be submitted in hard copy. Individuals should choose the method that works best for them.

  • Misconception 5: The DD 2870 form is the same as other healthcare forms.

    • This form has specific purposes and requirements that differ from other healthcare forms. It’s crucial to use the correct form to avoid processing delays.

  • Misconception 6: Personal information is not protected when submitting the DD 2870 form.

    • All personal information provided on the form is protected under privacy laws. The military takes measures to safeguard this information.

  • Misconception 7: Once the DD 2870 form is submitted, there is no need to follow up.

    • It is advisable to follow up after submission to ensure that the form was received and is being processed. This can help address any potential issues early on.

  • Misconception 8: The DD 2870 form is only needed for initial healthcare requests.

    • This form may also be required for ongoing healthcare services or changes in coverage. Understanding when to use it is essential for continued access to care.

  • Misconception 9: Anyone can fill out the DD 2870 form on behalf of a service member.

    • Only authorized individuals, such as the service member or their legal representatives, should complete the form. This helps ensure that the information is accurate and valid.

How to Use DD 2870

Completing the DD 2870 form is an essential step in the process that follows your request for certain benefits or services. After filling out the form, you will need to submit it to the appropriate authority for processing. Ensure that all information is accurate and complete to avoid delays.

  1. Begin by obtaining the DD 2870 form. You can download it from the official military website or request a physical copy from your local military installation.
  2. Carefully read the instructions provided with the form. Familiarizing yourself with the requirements will help you fill it out correctly.
  3. In the first section, enter your personal information. This includes your full name, Social Security number, and contact details.
  4. Next, provide information regarding your military service. Include your branch of service, rank, and service dates.
  5. In the subsequent sections, answer all questions accurately. If a question does not apply to you, indicate that clearly.
  6. Review your responses for accuracy. Double-check all entries to ensure there are no errors or omissions.
  7. Sign and date the form at the designated area. Your signature confirms that the information provided is true and complete.
  8. Make a copy of the completed form for your records before submission.
  9. Submit the form according to the instructions provided. This may involve mailing it to a specific address or delivering it in person to a designated office.
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