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  • Dd Form 771

Get Dd Form 771

EDITION IS COPY 2 - Entered in health record. Designed using Perform Pro, WHS/DIOR, Aug 96 Reset.

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How to fill out the Dd Form 771 online

Dd Form 771 is used for eyewear prescriptions and is essential in ensuring that individuals receive the correct glasses or contact lenses. This guide provides step-by-step instructions for filling out the form online, making the process clear and accessible for all users.

Follow the steps to complete the Dd Form 771 online effectively.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by filling in the account number and date fields on the form.
  3. In the 'To' section, specify the lab that will process the eyewear order.
  4. Under 'From', enter your name in the format of last name followed by first name. Include your Social Security Number (SSN) and grade.
  5. Provide your address and continue with the address if necessary. Ensure that the information is complete for accurate delivery.
  6. Indicate the shipping details by completing the 'Ship To' section, including the clinic, patient’s name, and city/state/zip code.
  7. Fill out the eyewear specifications, such as frame type, lens options, and any special requirements.
  8. Complete the fields for eye prescriptions, including values for sphere, cylinder, axis, and prism if applicable.
  9. In the 'Special Comments/Justification' section, use this space to elaborate on any details indicated as 'Other' in the previous sections.
  10. Enter the prescribing officer or authority’s name and ensure to include their signature.
  11. Once all fields are complete, review the form for accuracy. You can then save changes, download, print, or share the completed form as needed.

Complete your Dd Form 771 online today for a seamless eyewear prescription experience.

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An example of an eyeglass prescription Here is a sample eyeglass prescription: OD -2.00 SPH +2.00 add 0.5 p.d. OS -1.00 -0.50 x 180 +2.00 add 0.5 p.d. In this case, the eye doctor has prescribed -2.00 D sphere for the correction of myopia in the right eye (OD).

DD Form 771, "EYEWEAR PRESCRIPTION"

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