Start here if you have been told to submit DD Form 877. First, know what you are filling: Medical/Dental Records or Information, Request For. The document is titled DD Form 877, Request for Medical/Dental Records or Information, September 1967.
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.
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.
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.
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.
For questions about a specific entry, check the form's own instructions, and if that does not settle it, open not stated. The directive controls where they differ.
Download the form
First, look at what you can download. The set covers PDF, the form runs 1 pages, and you will complete roughly 63 fields.
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
- Item 16. Remarks. Mark one. Press space bar
- Date.
- 1. Patient (last name, first name, middle name).
- 2. Organization and place of treatment.
- 3. Status. Press space bar to mark X in first box if military second box if VA beneficiary, third box if dependent, fourth box if Federal employee, or fifth box if other.
- 3. Specify other status.
- 3. a. Name of sponsor, if dependent.
- 5. Identifying information. a. Service number.
- 5. b. Grade/rate.
- 5. c. Social security number. Do not include dashes.
- 5. d. V. A. claim number.
- 5. e. Date of birth, if federal employee.
- 6. Dates of treatment, inclusive.
- 7. Disease or injury.
- 8. a. Records requested. Clinical. Mark X if Military.
- 8.a. Clinical records requested. Mark X if V.A.
- Item 8. a. Records requested. Outpatient. Mark X if military.
- 8.a. Outpatient records requested. Mark X if V.A.
- 8. b. Records forwarded - Clinical. Mark X if military.
- 8.b. Clinical. Mark X if V.A.
- 8. b. Records forwarded. Outpatient. Mark X if military.
- 8.b. Outpatient. Mark X if V.A.
- 8. a. Records requested. Health record. Mark X if Military.
- 8. a. Records requested. Dental record. Mark X if military.
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.
If the form points you to another document, you can find it by number alone. DD numbering runs across the whole Department, so you do not need to work out which service issued it — one number, one form, everywhere.
Here is where people go wrong. They see a number in an instruction and download whichever form matches it. But DA and DD are separate systems — Army-specific in one case, Department-wide under not stated in the other — so check which series you were sent to before you take the file.
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.
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?
- DD Form 877, Request for Medical/Dental Records or Information, September 1967
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?