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DD Form 2870 — DD Form 2870, Authorization for Disclosure of Medical or Dental Information, December 2003

Authorization for Disclosure of Medical or Dental Information

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DD Form 2870 is a Department of Defense form, not a service form: DD Form 2870, Authorization for Disclosure of Medical or Dental Information, December 2003, used to Authorization for Disclosure of Medical or Dental Information. The DD prefix is the operative fact. It means one blank serves every military department — Army, Navy, Air Force, Marine Corps, Space Force, Coast Guard under Defense jurisdiction — plus the defense agencies and combatant commands. No branch variant exists.

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.

Available: PDF, across 1 pages, roughly 36 fields. That is the whole scope of the download decision.

Take the fillable pdf unless you have a reason not to. Fillable means the boxes are real fields that accept typed text and retain it in the file. Printable means a flat blank — no fields, printer and pen only. The difference is not cosmetic: one produces a record that reproduces cleanly through scanning and forwarding, the other depends on penmanship.

What the form asks for

  • Section 1 - Patient Data. 1. Name (last, first, middle initial).
  • 3. Social Security Number. Do not include dashes.
  • 4. Period of treatment: From - to (4 digit year, 2 digit month, 2 digit day).
  • 2. Date of birth (4 digit year, 2 digit month, 2 digit day).
  • 5. Type of treatment. Press space bar to mark X in first box if outpatient, second box if inpatient, or third box if both.
  • Section 2 - Disclosure. 6. I authorize: (name of facility/TRICARE health plan):
  • 6.a. Release my patient information to: name of physician, facility, or TRICARE health plan.
  • 6.b. Address (street, city, state and zip code).
  • 6.c. Telephone (include area code).
  • 6.d. Fax (include area code).
  • 7. Reason for request/use of medical information (X as applicable). Mark X if personal use.
  • Mark X if insurance.
  • Mark X if continued medical care.
  • Mark X if retirement/separation.
  • Mark X if school.
  • Mark X if legal.
  • Mark X if other.
  • Specify other reason.
  • 8. Information to be released.
  • 9. Authorization start date (4 digit year, 2 digit month, 2 digit day).
  • 10. Authorization expiration. Mark X if date.
  • Specify expiration date (4 digit year, 2 digit month, 2 digit day).
  • Mark X if action completed.
  • Section 4 - For staff use only (to be completed only upon receipt of written revocation). 14. Mark X if authorization revoked.

Verify the edition before the first keystroke. The date on the form face should read not stated. If it does not, discard the file. Field numbering shifts between editions, and on a DD form the new layout reaches every receiving office in every service at once — there is no lag during which the old version is still normal somewhere.

Field-level questions go to the printed instructions, then to not stated, which is authoritative.

Send it as not stated or local guidance specifies. Save a copy. Cross-service and cross-agency routing is normal for Department forms, and a lost original outside your own organization is harder to chase down.

Look up cross-referenced forms by series and number. DD numbering is unified across the Department, which removes the usual step of identifying which service issued the thing.

Prefix before number. A DA citation and a DD citation in the same instruction point at separate systems — one Army, administered by an Army proponent, one Department-wide under not stated — and there is no correspondence between them at any number.

Editions change when the prescribing directive is reissued, when the data collected changes, or when notice language is amended. None of that reaches you. Checking not stated at download is the entire defence, and it is cheaper than repeating a submission.

What is here is the blank form and a description of it. What is not here is legal guidance or any assurance about a particular filing — this page is not the issuing authority and does not speak for one. Those questions go to not stated, to your servicing administrative office, or to the authority identified in not stated.

Questions and answers

What is DD Form 2870?
DD Form 2870, Authorization for Disclosure of Medical or Dental Information, December 2003
Which edition is current?
Not stated by the publisher
Who is responsible for this form?
Not stated
In which formats can it be downloaded?
PDF

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