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The scope here is Department-wide. DD Form 2642 — CHAMPUS Claim Patient's Request for Medical Payment — exists to CHAMPUS Claim Patient's Request for Medical Payment, and it applies across the services rather than inside one. That is what the DD prefix encodes: joint issue, single edition, every branch and defense agency working from identical paper.
Authority: not stated prescribes it, not stated maintains it. Those two names settle most disputes about why the form is being asked for. Local commands add timing on top; the requirement itself comes from above them.
Current edition is not stated, carried as not stated. Check that against any copy you already hold before doing anything else — Department-level revisions land everywhere simultaneously, so a stale file is stale across the whole Department.
The set is PDF. Size: unknown pages, about unknown fields. Everything below refines that choice.
Default to fillable pdf, print only when you must. The fillable file stores what you type; the printable file is a blank picture. A Department form often travels further than a service form — scanned, emailed, forwarded to an agency that never saw the original — and typed text is what survives that.
Xfdl is a legacy Department format, IBM Lotus Forms, requiring the matching viewer. Its survival in DD distribution reflects how widely it was fielded across the Department, not any advantage over pdf today.
Nothing costs anything here. Work in a full desktop pdf application rather than a browser preview; field behaviour in browsers is unreliable.
Edition check comes first, ahead of any entry. Compare the printed date to not stated and replace anything older. Department-level supersession is simultaneous across the services, so a superseded blank is not merely out of date locally; the office receiving it is already working from the new field structure whichever branch it belongs to.
Work the printed sequence: header, body, signature block. The order is functional rather than decorative, since entries below frequently key to identifying data above them.
Complete every field, N/A where an item does not apply, dates exactly as the form prescribes. A DD form crosses service lines, and a convention obvious in one branch is not obvious in the next.
Privacy Act Statement first, personal entries second. It names the authority for the collection, what the data is for, who else routinely sees it, and whether you have to answer at all.
Signature comes after everything else and must be a signature: pen, or a credentialed digital signature via Common Access Card. Typing does not qualify. Add the date at the same moment.
Review for the usual: old edition, blank required fields, illegibility on reproduction, date format, signature and date. Unclear entries — read the form face, then not stated; the directive prevails.
Submit to the office named in not stated or in local instruction; retain a duplicate before it leaves. Joint routing often sends a DD form across organizational boundaries, and tracing one afterward is not a same-day matter.
A number is a complete address in the DD series. Because the sequence is Department-level and not duplicated per service, there is nothing further to specify.
Do not read across from a service number. DA numbering is Army-specific under an Army proponent; DD numbering is Department-wide under not stated or an equivalent Department office. The sequences are unrelated, so identical digits in each identify two different documents. Read the prefix, not the digits.
Three drivers of revision: directive reissue, altered collection requirements, updated statutory notice text. No notification accompanies any of them, so download fresh and confirm not stated rather than reusing an archived file.
Limits of this page: it distributes a published Department of Defense document and describes it. No legal advice, no procedural ruling, no statement about whether any submission will be accepted. Applicability, eligibility and procedure belong to not stated, to a servicing personnel office, or to the office named in not stated.
Questions and answers
- What is DD Form 2642?
- CHAMPUS Claim Patient's Request for Medical Payment
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?