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  • P877 Form 2020

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The MHS GENESIS Patient Portal provides secure access to your medical and active duty dental health records, manage appointments, view lab results and exchange secure messages with your healthcare team.

DD Form 877, "REQUEST FOR MEDICAL/DENTAL RECORDS OR INFORMATION"

To request clinical and medical treatment records: Although not mandatory, using the NA Form 13042 is the recommended method to send a request for medical records/information. This form captures all the necessary information to locate a medical record. Please provide as much information on the form as possible.

Download form SF-180 to mail or fax your request. Where to Return the Form: Review the tables on page 3 of SF-180 to identify the correct location of the record you need (based on branch of service, dates of separation, and type of record) send the completed form to the address identified on the table.

The NPRC is the records custodian for most discharged and retired members of all branches of service. The fastest way to obtain a copy is through their website, at http://.archives.gov/veterans/. Expect a two to three week wait to receive requested records.

Authorization for Disclosure of Medical or Dental Information (DD Form 2870) Use this form to authorize an individual to release information that is protected under the Federal Privacy Act.

This form provides you the advice required by The Privacy Act of 1974. The personal information will facilitate and document your health care. The Social Security Number (SSN) of member or sponsor is required to identify and retrieve health care records.

PRINCIPLE PURPOSE(S): This form is to provide the Military Treatment Facility/TRICARE Health Plan with a means to request the use and/or disclosure of an individual's protected health information with respect to Substance Abuse related records.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232