Form 2870

How to Protect your Medical Information with DD Form 2870

DD Form 2870: Authorization for Disclosure of Medical or Dental Information

Today we’ll discuss a very specific form used by the Department of Defense. It’s a well-known fact that the active duty service members and their dependants are eligible for the TRICARE health care program. According to HIPAA Privacy Regulations, a health care provider or contractor may not release a patient’s medical data to a third party. Even spouses and relatives won’t have access to an individual’s medical records until that individual signs a written agreement. Department of Defense Form 2870 is an authorization agreement which must be signed so that the interested party can access protected medical records.

Who Needs DD Form 2870?

DD 2870 form is typically submitted by a TRICARE beneficiary (a military employee, a military retiree or their dependants) on the request of their provider or contractor. Filling out this form is not mandatory and can be denied.

What is the DD Form 2870 Form?

A filled out Form 2870 (Authorization for Disclosure of Medical or Dental Information) grants permission to share an individual’s protected health information to a third party or individual upon authorization of the disclosure for several purposes:

  • personal use
  • insurance
  • continued medical care
  • school
  • legal
  • retirement/separation, etc.

Is Form 2870 Form Accompanied by Other Forms?

There is no need to submit any other forms along with Form 2870.

When is Form 2870 Due?

The submission of the form is not regulated by any specific deadlines. However, the applicant must indicate the “Authorization Start Date” and “Authorization Expiration Date”, otherwise the request will not be processed.

How do I Fill out Form 2870 Form?

To be legal, the form must be completed in a comprehensive way and include the following information:

  • patient data (name, date of birth, SSN, period and type of treatment)
  • disclosure containing name of the facility or TRICARE health plan and necessary information about the party who asks for authorization
  • reasons for the request or use of medical information
  • information that is to be released
  • authorization start and expiration dates
  • signature and date

Where do I Send DD Form 2870?

The completed form should be sent to one of the TRICARE offices, depending on the beneficiary’s location. Here is the full list of addresses.

Integrating New Patients into a Dental Practice


David Wolf, DDS runs a small but successful private dentistry practice in Milford, West Boston. This tight-knit medical care provider develops an intimate relationship with its clients and focuses on providing the best care possible. “We specialize in adolescents to adults,” David Wolf said. And with seven employees and one dentist to cover “about 1500 active patients,” David Wolf needs to make his workflow as efficient as possible to ensure that he can integrate new patients into his care as rapidly as possible.

David Wolf, DDS

The Problem

Integrating new patients into thriving practice isn’t always easy. With 1500 patients already in his care, adding new patients was taking unnecessary time and energy away from those already in his care.

The old process of integrating new patients into his care was clumsy and time-consuming before Wolf switched to PDFfiller. “We have all digital charts so what was happening before, the patient could fill in the PDFs, but they’d have to print them out and bring them in. But then we’d have to scan them back into their digital chart and then we would shred them, so we were kind of chasing our tail,” Wolf said.

And that was when the office was fortunate enough to have patients follow through on their paperwork at home. Often, with Wolf’s previous solution, patients “either didn’t [complete the forms], which meant that when they showed up, we had to give them written forms to fill in in the waiting area, or if they did do it, they would bring it in, or sometimes they forgot them.”

Wolf knew that he needed to cut down on the time it took to integrate patients. Drawn by PDFfiller’s ability to easily make forms fillable and have them filled out digitally by clients, Wolf “figured out that I could probably set [PDFfiller] up [for business]. “We’re seeing about 20 new patients a month and the amount of time it would take to get the information on paper and scan it in and shred it was probably 15 minutes per patient, so probably about four hours of work per month” said Wolf.

Then Wolf tried PDFfiller and simplified his digital document management. Now, “we… use [PDFfiller] to process new patients,” said Wolf. And, “[The transition] was really simple for the office.”

The Solution: PDFfiller

Now, said Wolf, “we’re using [PDFfiller] for our patients to submit their medical history forms and insurance forms online.”

David Wolf’s front office depends on PDFfiller, saving them time and energy and making the process of integrating new patients into their care easier than ever.

The process of integrating PDFfiller into Wolf’s office workflow was easy:

“We already had the fillable forms ready to go,” said Wolf. “There was a little bit of effort getting the fillable link forms the way I wanted them,” but after uploading a document or downloading one from the internet, converting it into a fillable form is easy with PDFfiller’s drag-and-drop form creation wizard, which allows users to add fillable fields intuitively to a form with just a few clicks. Importantly for Wolf, PDFfiller allows parts of the form to be made mandatory including adding contact information – “since [with] the fillable forms, you can select what fields are required, it also saves us from having the patients not skip something… we [also] force patients to put their name and email address in when they submit the form so it allows us to match their name up with their digital chart in the office and import the information into their chart,” said Wolf, making the whole process much easier for Wolf’s front office.

After Wolf created his fillable form, he could then distribute it to patients in a number of ways. However, Wolf chose to integrate the fillable PDFfiller form into his website. “If we have a patient call for a new appointment, the easiest thing we do is we just have them go to our website and click on the link [to the fillable document],” said Wolf. “But if they’re not somewhere where they can do that right when they’re calling us, then we will get their email address and email them the link, so they can collect the email and click on the link to fill the forms out later.”

PDFfiller helps users with the powerful ‘LinkToFill’ feature, which allows PDFfiller users to send fillable forms to recipients to complete and return with just a click from inside PDFfiller’s easy-to-use online interface. You can also distribute forms with a URL or a QR code. PDFfiller’s powerful and proprietary ‘SendToSign’ feature makes it easy to create a form and send it others for a legally-binding electronic signature with just a click.

After a new patient completes a form, Wolf’s front office receives an email notifying them that a form has been completed by a specific new patient. The front office will “save the PDF information and then import it into the patient chart.” “[When] the patient arrives for their appointment, we have all their information,” said Wolf, making the check-in process quick and easy for Wolf’s front office and the patient.



PDFfiller is the fastest way to add patient data into Wolf’s database and new patients into his practice. “Probably [dealing with new patients’ forms takes] less than a half an hour’s worth of work [with PDFfiller],” said Wolf, “So it’s probably saving us close to three and a half hours of office work a month.” Wolf’s office has cut the time of processing intake forms by 87.5% using PDFfiller. “Being able to have [patients] be able to fill the forms out online and have them directly imported into their digital charts saves us a ton of time,” said Wolf. “It also saves us so much time because we do not have to scan the information back in and shred it as we did with the paper version.” Moreover, PDFfiller never saves customer data on its servers after the customer deletes his form — PDFfiller does the digital shredding for you.


Not only is PDFfiller the fastest way to fill out forms online, it is also the most convenient, making the new patient intake process easier for both patients and front office staff. “[PDFfiller] just makes it a lot more convenient for [new patients] if they want to have the forms ready before they get here,” said Wolf. Moreover, PDFfiller “streamlines the communication process and it decreases the amount of manual labor that we have to do to collect the patient data… it saves our office a huge amount of effort in collecting the patient data” and makes dealing with medical information and insurance companies much easier,” Wolf said.

Cost Savings

It’s difficult to quantify the value of PDFfiller, said Wolf. PDFfiller, though, saves the office time and energy and “for the cost of running a dental office, [the] $180/year subscription for PDFfiller is a really inconsequential amount of money. I think it’s really reasonably priced and I think it certainly pays for itself in convenience alone.”


PDFfiller makes it safer to transfer and store documents than other online services, or even keeping paper copies. Completely HIPAA compliant, PDFfiller makes digital document management secure. [Before PDFfiller] we had the fillable forms, but we weren’t having the patients email them to us because of the security thing. But having a secure portal where the patient can just fill in their form and submit it is the reason we decided to start doing it this way [with PDFfiller],” Wolf said.

Customer Service

PDFfiller’s customer service is available 24/7 to help users whenever they have a problem and make the most of the internet’s best complete document management solution. Customer service was] great, they helped me, they helped merge some documents together. I had a great response from customer service, for sure,” said Wolf.


At Wolf’s dentistry practice, PDFfiller has proven itself to be the best way to integrate new patients into the practice. Faster, easier, and safer than other solutions, PDFfiller makes the process better for both staff and the patients themselves. “So far we haven’t had any problems,” Wolf said. “The staff likes it because it saves them a lot of steps.”

PDFfiller has improved the rate at which new patients complete forms before coming into the office, making it easier and faster to integrate them into Wolf’s digital patient system. “We probably have about fifty percent response rate now, where the patients submit the form digitally,” said Wolf. And while “half [of the new patients] show up and do it on paper once they get [to the office], said Wolf, “our next step probably will be to actually use a tablet in our waiting area, so instead of filling out the form on paper in the waiting area, we’ll just have them fill it out on the tablet while they’re here, so we can just eliminate that extra paper step as well.” Wolf also hopes to integrate PDFfiller’s API functionality into the website of his other company, Dental Care Links, to process PDFforms and “incorporate PDfiller’s ability into [Dental Care Links’] functionality – two solutions in one location,” Wolf said.

As a digital document management solution, “I would definitely recommend it to any dentist or doctor that needs to have their patient fill in the medical history forms before they arrive,” Wolf said. “I think it’s a great solution.”

For the complete paper, click on the link below:


Using PDFfiller to Compile Boy Scout Forms and Send Permission Slips


The Boy Scouts of America are a large national organization with almost three million youth members and almost a million active adults. In existence since 1910, the Scouts have a long history of instilling self-reliance, patriotism, and character development in their members. They rely on a range of activities, education, and outdoor adventure.

As an assistant scout manager, Nathan Appel helps to lead a troop of these young scouts. A systems analyst by trade doing statistical analysis for research, Appel devotes much of his free time to the Boy Scouts.

The BSA was founded in 1910 and,
since then, more than 110 million
Americans have been participants in
BSA programs at some time.

The Problem

While organizing various activities and dealing with paperwork for the scouts, Appel found himself wasting time with paper documents and struggling with digital forms.

“Some of the forms that the Boy Scouts of America have are PDF forms, but they’re not fillable, they’re write-out,” said Appel. “And some of these [forms] have to be done multiple times a year in order to track service hours and all these other things that are important.”

Making sure that documents are completed and submitted properly and promptly is critical because “the boys need the service hours and all that counts towards making rank and getting to the final phase of Eagle Scout,” Appel said.

Before Appel started using PDFfiller, documents were being dealt with inefficiently digitally or having to be written out by hand. Then Appel found PDFfiller.

The Solution

Now Appel uses PDFfiller almost every week for his 40 Boy Scouts. PDFfiller expedites various workflows for Appel, from permission slips to tracking service hours.

For his permission slips, Appel digitizes them and adds fillable fields using PDFfiller’s easy drag and drop wizard. He can then distribute them to parents to complete electronically using PDFfiller’s powerful, ‘SendToSign’ feature which enables him to send the forms directly from PDFFiller using a link, URL, or QR code. Parents can then complete the forms from any internet-connected device, anywhere, and at anytime, add an electronic signature, and then return them digitally absolutely instantly. “For every outing that we go on, the boys have to fill out a permission slip,” said Appel, so “I made it fillable using PDFiller so now you can sign it online… If somebody forgets a permission slip, they can just send it to me electronically, they don’t have to go to the venue or whatever and I don’t have to follow up.”

Primarily, though, Appel relies on PDFiller to complete his Scouts’ “Journey to Excellence” forms digitally. PDFfiller allows Appel to create a template and edit a document using powerful tools quickly and easily. Moreover, PDFfiller allows Appel to consolidate and store these documents and edit them over the course of the year before he submits them. With PDFfiller, It’s easy to add and edit text at any time and from any internet-connected device and when you’re done, just sign the document with a legally binding electronic signature and save it, print it, or send it. Now, with PDFfiller, Appel can “take these forms that aren’t fillable and fill all this stuff in, which has been great.”

The Benefits of Using PDFfiller


PDFfiller is the fastest way to create, edit, send and sign PDF forms online. For Appel, it saves “probably an hour every time not writing it out, making a mistake, or anything like that. So I’ve done four forms, so at least four hours. And with the fillable form that saves everybody a multitude of hours.”


PDFfiller makes it simple to manipulate and distribute forms electronically – “it’s easy to use,” said Appel. Powerful features like ‘SendToSign’ make it easy to transmit documents like permission slips for signature while advanced editing tools allow users to highlight, redact, annotate, edit, and erase text from PDF documents easily. PDFfiller even allows users to add electronically binding digital signatures with just the click of a mouse. Moreover, PDFfiller allows you to consolidate and archive all of your documents in one place so you can edit, send, and sign them whenever you want, from any internet-connected device, anywhere.


PDFfiller saves time and money for organizations large and small. Save on the cost of paper and document postage; just as important though, save your time and energy for more important work by using PDFfiller to streamline your document management.


PDFfiller is the safest way to manage your documents. With PINs, two-factor authentication, audit trails, and unique document IDs, you can be sure your documents are safe. PDFfiller relies on Amazon’s S3 servers which offer redundant backups and high-level physical security, so you know your documents are always accessible, whenever and wherever you need them.


The average U.S. office worker uses 10,000 sheets of paper every year. Everyday, PDFfiller helps its users go green by allowing them to convert all of their document workflow to a paperless digital solution. It’s the best way to save the environment and streamline your workflow. After switching to PDFfiller, Appel found that “I’m not handling a lot of hard copy, which is good [for the environment].”


PDFfiller functions like a digital Swiss Army Knife for Appel’s Boy Scout troop, fulfilling a range of administrative needs.  “It worked well” on whatever task they applied it to, Appel said. Wherever you are, you can count on having the right tool for all your document needs, a flexible, powerful, and full-featured document management solution. Appel recommends PDFfiller and has found it useful, particularly for “something like the Boy Scouts where you have to have a [lot] of paperwork to hand in to the parent organization, anytime you can make it very clean and clear so none of the information gets lost for these boys, that’s always a plus.” PDFfiller is always there for Appel and his troop of Boy Scouts and will be a useful tool in years to come, as Appel applies it to “other forms that we have to do, …make PDFs from there, sign in sheets, all the other things, and just have it handle all the paperwork that we have to create.”

For the complete paper, click on the link below:


Using PDFfiller, Poly Pharmaceuticals Streamlined their HR Workflow


Poly Pharmaceuticals in Huntsville, Alabama focuses on offsite manufacturing and distribution of pharmaceuticals as well as developing and marketing products for treating a range of conditions, from coughs and colds to urological issues. Since 1980, they’ve been developing their own drugs in-house while working through business partnerships, licensing, and acquisitions, to bring innovative pharmaceutical products to the market and deliver quality drugs to patients in need.

Margaret Wood is Poly Pharmaceuticals’ HR and Accounting Director, taking responsibility for all HR functions, onboarding, and benefits administration. Her job requires her to deal with a plethora of documents and more importantly, manage professional relationships and day-to-day administration; she often relies on documents as the medium by which she connects with her coworkers.

The Problem

Wood was originally drawn to PDFfiller because it made it easy to complete PDFs and e-sign documents.

But before they integrated PDFfiller into their corporate workflow, Poly Pharmaceuticals was wrestling with a variety of problems with no easy solutions.

Onboarding is critical for Poly Pharmaceuticals to integrate new employees to their team and keeping them apprised of company developments and work progress. For Wood, “without an HRIS [Human Resource Information System], onboarding and getting documents returned in a timely manner was a nightmare. People would try to fax them and a page would get missed, delaying the onboarding process.” This made the hiring process longer and more complicated and slowed the rate at which these new hires could contribute to the work of Poly Pharmaceuticals.

Moreover, the day-to-day administrative tasks that HR handles were slow and inconvenient with a paper based solution:

“Requesting PTO [paid time off] and submitting expenses for approval would bottleneck during the approval process due to the required signatures. Employees would have to print, sign, scan and send [the requisite documents] to the Manager. The manager would then sign and forward [these documents] to HR. Employees ended up taking more than their accrued time or HR was constantly requesting approved expense reports. Also, some requests or expenses would get lost in the shuffle. This could be a 3-4 day process.”

Instead of a simple solution, dependance on paper documents meant that Wood was forced to have “constant communication with managers for missing documents,” said Wood. “It took too many man-hours to get all the information in a timely manner”. The result, said Wood, was “cut off dates were implemented with little success” and moreover, there was “confusion, stress and chaos for everyone.” The company prides itself on, and has a reputation for, maintaining good employee relationships and thus they needed a way to continue this without interference to ensure the satisfaction of current and new employees.

But switching to PDFfiller was easy and in only “about two hours [Poly Pharmaceuticals] change[d] all our documents to fillable and e-signature documents”, said Wood. Two minutes later, they had been uploaded to the CRM and the transition to PDFfiller was complete.

The Solution

With PDFfiller, processes that once took hours, now take just minutes. Everyday, 35-40 people at Poly Pharmaceuticals use PDFfiller to deal with document-based queries and administrative work.

Anywhere employees go, they can connect with HR and back office staff to coordinate, arrange business affairs, organize paid time off, get support with onboarding, etc. PDFfiller helps assuage the administrative burden on HR by making it easy to send documents and transmit information.

Because 85% of Poly Pharmaceuticals employees are mobile sales representatives, they rely on PDFfiller to transmit important information from the road. PDFfiller is available on any internet-connected device from anywhere at any time.

The process is easy — the back office can send the requisite documents out to mobile salespeople to complete while on the road. For administrative documents, “the forms reside on the CRM, employees fill them out, e-sign [them] and send [them back to] HR.”

Using PDFfiller’s proprietary ‘LinkToFill’ feature, Wood can turn administrative PDF documents into interactive fillable forms available to anyone to fill out at any time and from any device. The process is simple: Wood just needs to add fillable fields to the document using PDFfiller’s simple and convenient drag and drop wizard — no coding or hosting necessary. Wood can then send the documents to specific employees for completion whenever it is needed and wherever they are with just the click of a mouse.

“PDFs cross all devices and it has eliminated the need for a scanner, printer etc.,” said Wood, citing one of the major advantages of PDFfiller.

If a mobile salesperson needs to provide specific information to the home office while on the road or get approval from management, it’s simple to send a document to the back office for signature using PDFfiller’s ‘SendToSign’ feature. The ‘SendToSign’ feature allows users to request a signature from a anyone, anytime, and from anywhere in just a few clicks.

With PDFfiller, “[employees] can use their mobile devices anywhere there is [internet] to access the [fillable] forms, freeing them up to take care of business,” said Wood. “They absolutely love the freedom and easy access and (almost) instant approvals.”

The advantages are numerous — Wood saves time and energy and for Poly Pharmaceuticals, using PDFFiller expedites business and simplifies HR work.



Processes that once took days, now take just minutes with PDFfiller. Onboarding, editing, and signing documents were faster once Poly Pharmaceuticals went digital. PDFfiller’s powerful and proprietary features like LinkToFill and SendToSign makes collaborating with colleagues and clients and collecting signatures faster than a paper-based document solution.


PDFfiller is always available from any internet-connected device, at anytime, anywhere. Easy-to-use editing tools allow you to redact, highlight, and edit documents and add sticky notes. And even with these powerful features, PDFfiller is still simple — it is “quite easy [to use],” said Wood, “even those who claim not to be ‘computer-savvy’ use it on a regular basis.”


PDFfiller is a completely online solution, which means that documents can be edited, signed, and sent from anyone on the road anywhere and from any internet connected device. There is no longer a need for pens and paper, printers and scanners, when you have the complete mobile online document solution at your fingertips all the time.


PDFfiller is an ultra-secure document management solution. Many organizations and care providers in the healthcare and medical field value PDFfiller’s HIPAA compliancy; for Wood and Poly Pharmaceuticals, security was a concern because they were sending and storing new hire applications and personal documents with sensitive information. Moreover, PDFfiller allows users to password protect specific documents for an added layer of protection and enable two-factor authentication, the same level of electronic security most banks use. It also offers ‘Audit Trail’, which allows you to monitor account activity and see any access to your account or changes to your document as well as see when and from where they were filled out and signed.

Ecological Benefits

PDFfiller doesn’t just save Poly Pharmaceuticals time and money, it also helps them save the environment — going green is easy with PDFfiller. The average US office worker uses 10,000 sheets of paper every year; PDFfiller helps reduce that figure substantially. “Absolutely,” the ecological benefits of PDFfiller were appealing, said Wood.With PDFfiller, Poly Pharmaceuticals can “save a tree — or thousands!”.


PDFfiller has helped Margaret Wood and Poly Pharmaceuticals streamline and improve their workflow. “We are using [PDFfiller] to the max” in order to expedite various HR processes, said Wood. And with the implementation of PDFfiller, “the collateral benefits cannot be touted enough — [we are] reducing paper flow, increasing productivity time, and boosting [employee] morale”.

Switching to PDFfiller “made sense!” said Wood. Because now Poly Pharmaceuticals has “documents [that employees] can e-sign [and] send directly to HR for approval,” Wood said, it is a “problem solved!” But not only did switching to PDFfiller solve specific problems in Poly Pharmaceutical’s workflow, it also translated across their business, particularly in the work and morale of employees. “Big WIN!” said Wood.

For the complete paper, click on the link below:


irs identity theft process, irs identity theft form 4535, irs identity theft hotline, irs form 14039 2015, irs identity theft pin, irs identity theft letter, irs identity verification, irs identity protection specialized unit, identity theft affidavit sample letter, irs form 14039 joint return, idverify irs gov 1040, idverify irs gov refund, idverify irs gov gov, irs identity verification quiz, irs verify identity questions

IRS Form 14039: Resolving Damage from Identity Theft

IRS Form 14039: Identity Theft Affidavit

No one is protected against identity theft these days. With computer technologies getting smarter, your sensitive information is always at risk. Each year the amount of data breaches grows. Unfortunately, the predictions for 2017 are also quite discouraging though we hope most of them won’t come true. However, if the worst comes to the worst and you’ve discovered that you`ve fallen victim to identity fraud, don’t wait. The earlier you start acting, the more chances you have to resolve damage from you identity theft. This is where the IRS steps in. It offers a solution for you which lies in completing IRS Form 14039. So how can you benefit from this document? Below is a brief yet comprehensive information about the form.

Who needs an IRS Form 14039?

If your identity has been stolen or you feel that your sensitive information is at risk, fill out form 14039. To put it short, the Identity Theft Affidavit is designed for actual or potential victims of identity theft. It is a kind of request sent to the IRS to mark individual`s account and identify questionable activity.

What is the IRS Form 14039 for?

Consequently, 14039 should be completed in the following situations:

  • in response to a mailed notice or letter from the IRS;
  • when filing 14039 form on behalf of another person, such as a deceased spouse or other deceased relative (Sections A, B, and D should be filled out).

With the 14039, you actually state the identity theft which affected your federal tax records or a statement of an event involving your personal information that may affect your federal tax records in future.

Whatever the case, you will need to describe your problem, explaining the reasons for your apprehension. The IRS will review your appeal and take action based on the information provided by you.

Is the IRS Form 14039 accompanied by other forms?

To get things going, you should submit one clearly legible copy of at least one of the following documents to verify your identity:

  • Passport;
  • Driver’s Licence;
  • Social Security Card;
  • Other valid U.S. Federal or State government issued identification.

But mind, if you are completing 14039 on behalf of another person, attach the documentation for that person respectively. Plus, make it visible and legible.

When is IRS Form 14039 due?

You can file this affidavit at any time when it becomes necessary. It is best to do it the moment you’ve discovered your identity has been stolen.

How do I fill out IRS Form 14039?

Luckily, 14039 is only two pages long. You will need to enter your personal information, indicate the reasons that made you to apply to the IRS, or the identity of the person you represent if this is the case.

Where do I send the IRS Form 14039?

You can send the completed form either via mail or via fax. Each of the methods depends on the specifics of your case.

For the final destination address of an IRS 14039, you should look through the last page of the form.

Hope your identity information is strongly protected. But if you have doubts PDFfiller is ready to provide you with the latest version of 14039 so that you can react quickly to any suspicious activity in your account.