You need DD Form 2876-1, and this page gives you the blank plus the steps for handling it. Start with what the form does: TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (EAST). Its official title is DD 2876-1, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form.
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.
After that, turn to timing. The requirement comes from not stated; the form is maintained by not stated. Local implementing instructions fill in the dates, so check with the office that will receive your copy.
Finally, decide how you will complete it. You can type into a fillable file or print a blank and write by hand, and the rest of this page walks you through both paths in order.
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.
Your first action is verification. Find the edition date on the form and match it against not stated. A mismatch means you are working from a superseded printing, and because DD forms change Department-wide rather than service by service, the office receiving it will notice.
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
Step one is picking the format. You have PDF to choose from, across 5 pages, with approximately 152 fields to complete.
Choose pdf as your default. Next, click inside a box. A fillable pdf responds by outlining the field and letting you type; the text stays in the document when you save it. A printable pdf does not respond, which tells you to print the page and complete it by hand.
Type when you can. Printed entries stay legible after the form is scanned, copied and forwarded, and handwriting often does not survive that trip. If you must write by hand, use block capitals and press firmly.
What the form asks for
- Contractor's website.
- TRICARE Prime option desired. Press space bar to mark X in first box if TRICARE Prime, second box if TRICARE Prime Remote, third box if TRICARE Overseas Program Prime, or fourth box if Uniformed Services Family Health Plan.
- Section I - Sponsor information. 1. Sponsor name (last, first, middle initial) (must match DEERS).
- Sponsor's social security number or DoD Benefits Number (DBN).
- 3. Sponsor is: X first box if active duty, second box if retired, third box if deceased, or fourth box if unremarried former spouse.
- 4. Sponsor's work telephone number (include area code/extensions).
- 5. Sponsor's email address.
- 7. Sponsor's residence address (street, apartment number, city, state, zip code, country).
- X if new address.
- 8. Sponsor's mailing address (provide APO or FPO if stationed overseas).
- X if same as residence address.
- X if new address.
- 9. Sponsor's military assignment. a. Unit.
- b. Unit identification code (if known).
- c. State, zip code and country of work address.
- 10. Requested action. X first box if none for sponsor (go to section II - family), second if enroll, third if transfer enrollment, fourth if PCM change, or fifth if disenroll.
- 11. Sponsor primary care preference. a. PCM, first choice. X first box if military treatment facility, second box if PRP (active duty only), third box if civilian.
- Primary care manager full name or MTF/clinic.
- b. Second choice. X first box if military treatment facility, second box if civilian.
- Primary care manager full name or MTF/clinic.
- c. PCM specialty. X first box if no preference, second box if family/general practice, third if internal medicine, or fourth if flight medicine.
- d. Preferred PCM gender. X first box if no preference, second box if male, third box if female.
- Section II - Enrolling family members. 12.a. First family member name (last, first, middle initial) (must match DEERS).
- b. Date of birth (4 digit year, 2 digit month, 2 digit day).
Submit the completed form through the channel not stated or your local guidance specifies. Save a copy for yourself before it leaves your hands, whether that means a scan, a photograph or a duplicate file.
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.
Watch out for one trap here. If your instructions cite a DA form as well, do not assume the numbers are connected. DA numbering belongs to the Army alone; DD numbering belongs to the Department and is administered by not stated or another Department office. The same number in each system means two unrelated forms, so read the prefix before you download.
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.
Before you go, note what is not covered here. You have the blank form and instructions for completing it; you do not have legal guidance, and no statement on this page determines what any office will do with your submission. Direct those questions to not stated, to the personnel office that serves you, or to the office designated in not stated.
Questions and answers
- What is DD Form 2876-1?
- DD 2876-1, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?