U.S. DOD Form dod-dd-771 (THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974 - Use DD Form 2005.) EYEWEAR PRESCRIPTION TO: (Lab) DATE ACCOUNT NUMBER ORDER NUMBER FROM: NAME (Last, First) SSN GRADE ADDRESS/UNIT.
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How to fill out the Dd771 online
The Dd771 form, also known as the eyewear prescription form, is an essential document used for ordering eyewear within the U.S. Department of Defense. This guide will provide you with clear, step-by-step instructions to complete the form efficiently.
Follow the steps to fill out the Dd771 accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the account number and the date in the respective fields at the top of the form. Ensure that this information is current and accurate.
- In the 'To' field, specify the laboratory that will be processing the eyewear order. This should be followed by the order number, which helps in tracking the request.
- Complete the 'From' section with the patient's details, including their name (last and first), social security number (SSN), grade, and contact information including phone number and address.
- Fill in the ‘Ship to’ section with the clinic name, patient details, city, state, and zip code to ensure proper delivery.
- Provide the eyewear specifications, including options for 'frame,' 'lens,' and other details. Indicate the required values in the 'AD' fields, including distance and near vision requirements.
- In the additional specifications fields, including 'H prism,' ‘V prism,’ and 'deceneter,' enter specific measurements provided by the prescribing officer.
- Utilize the 'Special comments/justification' section to provide any necessary explanations or further requirements related to the eyewear prescription.
- Finally, ensure the prescribing officer’s name, distribution details, and signature are completed before finalizing the form.
- Once all sections are filled out thoroughly, you can save your changes, download, print, or share the completed Dd771 form as needed.
Complete your Dd771 form online today to ensure timely processing of your eyewear order.
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