DD Form 2870

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What is DD Form 2870?

The DD Form 2870 fillable is a one-page document that allows military people to authorize TRICARE to release confidential information such as their insurance, medical, and dental information to third parties. No additional documents are required, as well as the applicant's signature, since filling out this document is voluntary.

DD Form 2870 on PDFLiner

What do I need the DD 2870 Form for?

  • The military uses the DD Form 2870 fillable PDF to authorize TRICARE to disclose medical information to third parties.
  • You can choose the person who will have the right to request such data, indicate the cases in which it might be required, and list the information that can be disclosed.
  • According to the official DD Form 2870 instructions, this permission is completely voluntary. Do not fill out this form if you do not want other people to see your health or insurance information.

How to Fill Out DD Form 2870?

  1. Enter personal details: your name, SSN, date of birth, and period and type of treatment.
  2. Next, complete the disclosure section. Specify who can disclose your information (name the facility) and to whom (other facilities, your physician, and so on). Check one or more reasons why it might be necessary, and also specify what data is to be disclosed.
  3. Enter the period for which this permit is valid. Remember, you can revoke it at any time.
  4. If a legal representative fills in the DD Form 2870 blank for the applicant, they must enter their data and sign.
  5. The fourth section should be left empty. Staff fills it out in case of this permission revocation.

Organizations that work with DD Form 2870 Medical Records

  • TRICARE

Fillable online DD Form 2870
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