Fillable Military Forms

DD Form 2870 — DD Form 2870, Authorization for Disclosure of Medical or Dental Information, December 2003

Authorization for Disclosure of Medical or Dental Information

You have arrived looking for DD Form 2870. Before you download, confirm this is the right document: Authorization for Disclosure of Medical or Dental Information. Full title: DD Form 2870, Authorization for Disclosure of Medical or Dental Information, December 2003.

Your second step is the edition, not stated, listed as not stated. Your third is scope. Because the number carries a DD prefix, you use the same blank as every other military department and defense agency; no service-specific version exists for you to hunt down.

Once you know the form fits, find out when you file it. not stated sets the requirement, and not stated maintains the form itself. Your own command or agency adds local timing on top of that, so ask your administrative office if the deadline matters to you.

Before you download, pick your approach — editable file or printed page. What follows covers the formats first, then the entries, then what you do afterward.

Begin at the top and move down. Enter your identifying data first, then the body of the form, then the signature block. The sequence is printed in that order because entries below frequently follow from entries above.

Check the edition before you type a word. The date appears on the face of the form; it should read not stated. When it does not, discard the file and take a fresh copy from this page. Department-level revisions replace the blank across all services simultaneously, which means an old printout can be out of step everywhere.

If a particular field puzzles you, read the instructions printed on the form first, then go to not stated. When the two disagree, follow the directive.

Download the form

Begin by choosing a file. Available here: PDF. Plan for 1 pages and about 36 entries.

Handle xfdl in two steps. First confirm you have IBM Lotus Forms Viewer or a compatible reader on your machine; ordinary pdf software will report the file as broken. Once the viewer is running, download and fill the form.

You will not be charged for any of these; the whole set is free. Before you start entering data, save the file to your computer and open it there. Fields behave far more reliably in a desktop reader than in a browser preview.

What the form asks for

  • Section 1 - Patient Data. 1. Name (last, first, middle initial).
  • 3. Social Security Number. Do not include dashes.
  • 4. Period of treatment: From - to (4 digit year, 2 digit month, 2 digit day).
  • 2. Date of birth (4 digit year, 2 digit month, 2 digit day).
  • 5. Type of treatment. Press space bar to mark X in first box if outpatient, second box if inpatient, or third box if both.
  • Section 2 - Disclosure. 6. I authorize: (name of facility/TRICARE health plan):
  • 6.a. Release my patient information to: name of physician, facility, or TRICARE health plan.
  • 6.b. Address (street, city, state and zip code).
  • 6.c. Telephone (include area code).
  • 6.d. Fax (include area code).
  • 7. Reason for request/use of medical information (X as applicable). Mark X if personal use.
  • Mark X if insurance.
  • Mark X if continued medical care.
  • Mark X if retirement/separation.
  • Mark X if school.
  • Mark X if legal.
  • Mark X if other.
  • Specify other reason.
  • 8. Information to be released.
  • 9. Authorization start date (4 digit year, 2 digit month, 2 digit day).
  • 10. Authorization expiration. Mark X if date.
  • Specify expiration date (4 digit year, 2 digit month, 2 digit day).
  • Mark X if action completed.
  • Section 4 - For staff use only (to be completed only upon receipt of written revocation). 14. Mark X if authorization revoked.

Now that it is complete, send it where not stated or your local procedure says it goes. Before you do, make yourself a copy — scan it or save the file elsewhere. It costs you nothing and saves you the whole exercise if the original goes missing.

Should you need a related form, look it up by its number. The DD sequence is Department-wide, which makes your search simple: no service qualifier, no branch-specific variant to track down.

Be careful when a procedure pairs this form with a service form. Read the prefix, not just the digits. Service forms answer to a service proponent, while DD forms answer to not stated or an equivalent Department office, and the two sequences were never aligned. Grabbing the wrong prefix gets you a form that has nothing to do with your task.

Do not archive this file and reuse it in a year. Forms are reissued as directives are revised, as data requirements shift, and as statutory notice text is amended. Your protection is simple: download fresh each time and confirm the edition date.

Finally, understand the limits of what you have read. This page distributes a published Department of Defense form and describes how to fill it out. It does not give legal or procedural advice, and it cannot promise any outcome for your particular case. For that, contact not stated, your administrative office, or the authority identified in not stated.

Questions and answers

What is DD Form 2870?
DD Form 2870, Authorization for Disclosure of Medical or Dental Information, December 2003
Which edition is current?
Not stated by the publisher
Who is responsible for this form?
Not stated
In which formats can it be downloaded?
PDF

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