Get Dd2526

The Dd2526 form is a crucial component for reporting medical malpractice claims within the U.S. Department of Defense. This guide provides step-by-step instructions tailored to help users fill it out accurately and efficiently online.

Follow the steps to complete the Dd2526 form effectively.

1. Press the ‘Get Form’ button to retrieve the Dd2526 and open it in the online editor.
2. Begin with the date of the report. Enter the date in the format YYYYMMDD.
3. Fill in the claimant's last name and the report control symbol, which is DD-HA(AR)1782.
4. Select the type of report by marking one option provided.
5. Provide the dates of the act(s) or omission(s). Enter both the beginning and ending dates in YYYYMMDD format.
6. Indicate the date the claim was filed as well as the date of any judgment or settlement in YYYYMMDD format.
7. Complete the medical treatment facility section by providing the facility name and DMIS code.
8. Enter the practitioner's information, including their name, SSN, date of birth, and licensing information such as state and license number.
9. Select the type of practitioner and specialties by marking all relevant options.
10. Fill in the patient demographics, including the patient's name, age, sex, and SSN of the sponsor.
11. Document the diagnoses and procedures performed using the ICD9-CM codes.
12. Describe the patient's allegations of negligent care, limiting your description to 300 characters.
13. Include details of the malpractice claim management such as the amount claimed, adjudicative body case number, and outcome.
14. Assess and document the professional review, identifying the cause and the location of care.
15. Answer the evaluation of care and assessment questions, ensuring to check the appropriate options.
16. Once completed, review all entries for accuracy before saving your changes, downloading, printing, or sharing the form.

Get started now by filling out your Dd2526 form online.