DD FORM 877 SEP 67 REPLACES EDITION OF 1 JAN. 60. WHICH MAY BE USED. Reset USAPPC V1. 00 Adobe Professional 7. REQUEST FOR MEDICAL/DENTAL RECORDS OR INFORMATION REQUESTING ACTIVITY -Complete Items 1 through 10 Except 8b also ADDRESSEE DATE complete Item 19. - Complete Items 8b 11 to 14 or 15 to 18 as appropriate final referrer shall return to requester. 1. PATIENT Last Name - First Name - Middle Name 3. STATUS MILITARY VA BENEFICIARY FEDERAL EMPLOYEE DEPENDENT 2. ORGANIZATION AND PLACE OF TREATMENT OTHER Specify 3a* NAME OF SPONSOR If dependent 4. TO Include ZIP Code IDENTIFYING INFORMATION a* SERVICE NUMBER b. GRADE/RATE c* SOCIAL SECURITY ACCOUNT NO. d. VA CLAIM NUMBER e. DATE OF BIRTH If Federal employee 6. DATES OF TREATMENT Inclusive a* RECORDS REQUESTED MIL VA 7. DISEASE OR INJURY b. RECORDS FORWARDED MIL VA 9. REMARKS CLINICAL OUTPATIENT HEALTH RECORD DENTAL RECORD X-RAY MEDICAL REPORT CARDS EMERGENCY MEDICAL TAGS FIELD MEDICAL CARDS ABSTRACT OF RATING SHEET REPORT OF PHYSICAL E....
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How to fill out the Dd Form 877 online
Filling out the Dd Form 877, Request for Medical/Dental Records or Information, is a straightforward process that can be completed online. This guide provides step-by-step instructions to assist you in accurately completing and submitting the form.
Follow the steps to successfully complete the Dd Form 877 online.
- Click 'Get Form' button to access the Dd Form 877 and open it in your preferred editing tool.
- Begin by filling out the patient information in Item 1. Provide the last name, first name, and middle name of the individual requesting the records.
- In Item 2, specify the organization and place of treatment. This ensures that the records can be accurately retrieved.
- Complete Item 3a if the person requesting the records is a dependent, entering the name of the sponsor.
- For Item 4, write the address to which the records should be sent, including the ZIP code.
- Fill out the identifying information in Item 5, including the service number, grade/rate, social security account number, VA claim number, and date of birth if applicable.
- In Item 6, indicate the dates of treatment for which you are requesting records.
- Item 7 requires you to specify the disease or injury related to the requested records.
- For Item 8, check the appropriate boxes for the types of records requested, clarifying your needs.
- In Item 9, you may add any remarks that could assist in processing the request.
- Complete Item 10 with your signature to validate the request.
- Proceed to Items 11 to 18 for any necessary referrals or replies, providing signatures and dates as required.
- Finally, ensure that Item 19 has the complete return address to which the records or final reply should be mailed.
- After thoroughly reviewing your entries, save the changes, and proceed to download or print the completed form.
Get started on completing the Dd Form 877 online today!
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Get answers to your most pressing questions about US Legal Forms API.
How do I get my full military medical records?
You can request your military records in any of these ways: Mail or fax a Request Pertaining to Military Records (Standard Form SF 180) to the National Personnel Records Center (NPRC). ... Write a letter to the NPRC. ... Visit the NPRC in person. Contact your state or county Veterans agency. Hire an independent researcher.
How long are military medical records kept?
In general, an individual's military records are maintained by each branch of the military for around 5-10 years after the service member separates, after which records are sent to the National Archives where they are permanently maintained. You can request copies of records directly from the National Archives.
What form do I use to request military health records?
DD Form 877-1 is the only request form which NPRC will accept from military facilities for retired medical treatment records.
How do I request my military medical records?
Resources and support. Call us. 800-698-2411. Visit a medical center or regional office. Find a VA location.
Does the military check your mental health records?
Contrary to what some people think, enlisting is not simply a matter of signing papers at an eager recruiter's office. Your physical and mental health will be carefully evaluated. The Army may check medical records if there are red flags about the recruit's fitness for duty.
What is DD Form 877?
DD Form 877, "REQUEST FOR MEDICAL/DENTAL RECORDS OR INFORMATION"
Does the military have my medical records?
Because the military does not routinely pull medical records, recruits who pass their physical and reveal no prior history may get in. However, if the soldier later gets sick or injured, the Army can check medical records if an undisclosed pre-existing condition is suspected.
How long does it take to get military medical records?
Allow about 10 days for us to receive and process your request, then you may check the status of your request. These forms are ONLY for status updates for EXISTING requests from the National Personnel Records Center (NPRC).
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