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REQUEST TO RESTRICT MEDICAL OR DENTAL INFORMATION PRIVACY ACT STATEMENT In accordance with the Privacy Act of 1974 (Public Law 93-579), the notice informs you of the purpose of the form and how it.

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How to fill out the Dd Form 2871 online

Filling out the Dd Form 2871 online can help you request restrictions on your medical information. This guide provides a clear, step-by-step approach to ensure you complete the form correctly and efficiently.

Follow the steps to fill out the Dd Form 2871 online

  1. Click ‘Get Form’ button to obtain the form and open it in the document editor.
  2. In Section I, enter your name in the format: Last, First, and Middle Initial. This ensures proper identification.
  3. In Section II, specify who the request for restriction is directed to. Enter the name of the physician, facility, or TRICARE Health Plan.
  4. In Section III, read the statements carefully before signing to acknowledge your understanding of the conditions regarding the restrictions.
  5. Review all entered information for accuracy. Save changes, download the completed form, print it, or share it as needed.

Complete your Dd Form 2871 online today to ensure your medical information is protected.

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DD FORM stands for Department of Defense Form Military and Government.

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