Start here if you have been told to submit DD Form 877-1. First, know what you are filling: Request for Medical/Dental Records from the National Personnel Records Center (NPRC) (St. Louis, Missouri). The document is titled DD Form 877-1, Request for Medical/Dental Records from the National Personnel Records Center, April 1998.
Next, check the edition. You want not stated, currently carried as not stated by the publisher. Then confirm the form applies to you — this is a Department of Defense form, so you use it whether you serve in the Army, Navy, Air Force, Marine Corps, Space Force or Coast Guard under Defense jurisdiction.
Then settle the schedule. You are working under not stated, with not stated responsible for the document, and your organization layers its own deadlines on that. Ask before you assume a date.
Last in this stage, choose your method: complete it on screen, or print the blank form and fill it out in pen. The sections below take each route step by step.
Now fill it in. Work from the top of the page downward, and do not jump ahead — the identifying block comes first, the substance of your entry second, the certification last. Later boxes often depend on what you put at the top.
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.
Look up an unclear item on the form face before anywhere else, then in not stated. Should the two texts conflict, the directive is the one you follow.
Download the form
Step one is picking the format. You have PDF to choose from, across 2 pages, with approximately 63 fields to complete.
Take the pdf if you are unsure. Then check which kind you have: if the boxes highlight when you click them, you have a fillable pdf and can type straight into it, and your entries save with the file. If nothing highlights, you have a printable pdf — send it to a printer and use black ink.
Prefer typing over writing. Your form will likely be scanned and emailed onward, and typed text reproduces at every stage while pen strokes fade or blur. When you do write, print in capitals so the receiving clerk can read it.
What the form asks for
- 1. Request date (4 digit year, 2 digit month, 2 digit day).
- 2. Patient's name at time of treatment (last, first, middle).
- 3. Year of treatment (1st digit).
- 3. Year of treatment (2nd digit).
- 3. Year of treatment (3rd digit).
- 3. Year of treatment (4th digit).
- 4. Name of facility where patient was treated.
- 5. Disease or injury.
- 6. Status at time of treatment. Press space bar to mark X in first box if military, second box if retired military, third box if dependent, fourth box if federal employee, or fifth box if other.
- 7. Identifiers. a. If Military. (1) Social Security number.
- 7.a. (2) Service number, if applicable.
- 7.a. (3) Branch of service (at time of treatment).
- 8. Type of treatment. X first box if inpatient, second box if health record, third box if dental, fourth box if psychiatric/consultation.
- 7. Identifiers. b. If Retired Military. (1) Social Security number.
- 7.b. (2) Service number, if applicable.
- 7.b. (3) Branch of service (at time of treatment).
- 7.b.(4) Date retired (4 digit year, 2 digit month, 2 digit day).
- 8. Type of treatment. X first box if inpatient, second box if outpatient, third box if dental, fourth box if psychiatric/consultation.
- 7. Identifiers. c. If dependent: (1) Sponsor's Social Security number.
- 7.c.(2) Sponsor's name (last, first, middle initial).
- 7.c. (3) Other dependent information.
- 8. Type of treatment. X first box if inpatient, second box if outpatient, third box if dental, fourth box if psychiatric/consultation.
- 7. Identifiers. d. If Federal Employee or e. Other. (1) Social Security number.
- 7.d. (2) Date of birth (4 digit year, 2 digit month, 2 digit day).
With the form finished, route it to the office named in not stated or in your organization's own instruction. Keep a copy first. People rarely regret having one and frequently regret not having one.
When DD Form 877-1 references another form, search on the series and number. Because DD numbers are common to every military department, the number by itself identifies exactly one document.
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.
Come back and check the edition next time you need this form. Editions change when the prescribing directive is reissued, when the information collected changes, or when the required notice language is updated, and none of those events reaches you directly. Verifying not stated at the moment you download is the whole defence.
One thing this page does not do: tell you whether your submission will be accepted. We publish the document and explain how to complete it, and that is where our role ends. Nothing here is legal advice. Take questions about eligibility, applicability or procedure to not stated, to your servicing personnel office, or to the office named in not stated.
Questions and answers
- What is DD Form 877-1?
- DD Form 877-1, Request for Medical/Dental Records from the National Personnel Records Center, April 1998
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?