Get Dd Form 2870

Filling out the DD Form 2870 online is a straightforward process that allows TRICARE beneficiaries to authorize the release of their medical or dental information. This guide will help you navigate each section of the form effectively, ensuring you provide all necessary information accurately.

Follow the steps to fill out the DD Form 2870 online.

1. Press the ‘Get Form’ button to obtain the DD Form 2870 and open the document in your editor.
2. In Section I, complete the beneficiary or patient’s information. Fill in their name, date of birth, and social security number. Under the period of treatment, indicate the start and end dates, and select the type of treatment (outpatient, inpatient, or both).
3. Move to Section II, where you designate who may release information. Enter 'Health Net/TRICARE' in Item 6. For Items 6a-6d, provide the authorized representative's name and contact information, such as the name and numbers of a partner or parent.
4. In Item 7, specify the purpose for which the information will be disclosed. Use Item 8 to clarify any additional details regarding the date range or type of treatment desired for disclosure.
5. Fill in Item 9 to confirm the authorization start date, which will be effective upon receipt. In Item 10, note that if no specific expiration date is provided, the authorization will expire one year from the date received.
6. In Section III, complete the release authorization by signing and dating the form. If the authorization is signed by a representative, attach documentation of their authority.
7. Once all sections are filled out accurately, review your information for completeness and correctness. Save your changes, then proceed to download or print the document if needed before sharing or submitting it.

Complete the DD Form 2870 online to ensure your medical or dental information is authorized for release promptly.