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.

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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.

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Figure Out Your Eligibility for Health Benefits with the VA 10 10EZ Form

VA 10 10EZ Form: Application for Health Benefits

All eligible US veterans served in the active military can apply for health benefits. These benefits include all necessary inpatient hospital care and outpatient services as well. It’s very important that the Department of Veterans Affairs takes cares of the veterans and offers all the necessary conditions for the maintenance of their health. The medical facilities for veterans provide various medical services, such as surgery, mental health therapy, radiology, physical therapy, and others. The range of medical services can vary according to the veteran’s eligibility status. In other words, each veteran will have his own package of health care benefits. To start the application process, the veteran has to fill in a special form – VA 10 10EZ. The procedure of enrollment is very simple and takes only half an hour. Read more to learn all the details.

Who needs the VA 10 10EZ form?

This form is used those veterans who want to enroll in the healthcare system provided for them. The application can be completed by the veteran or any person on his behalf. In order to receive healthcare benefits, the veteran must be eligible. The veteran must prove that the health problems were incurred during active military, naval or air service.

What is the purpose of the VA 10 10EZ form?

The information provided in this form is used by the Department of Veterans Affairs to determine the veteran’s eligibility for health benefits under the health care system. The financial information is used to determine the amount of monetary compensation.

What other documents must accompany the VA 10 10EZ form?

The application can be accompanied by a number of documents. If the veteran is not currently receiving benefits from the VA, he can attach a copy of the discharge or separation papers from the military, such as DD-214. The veteran should also attach copies of insurance cards, Medicare or a Medicaid card.

When is the VA Form 10 10EZ due?

The application has to be submitted when the veteran needs it. The estimated time for completing the application is thirty minutes.

What sections should I complete in the application?

The veteran must complete the following sections:

  • General Information: veteran’s name, mother’s maiden name, gender, nationality, race, social security number, date of birth, address, phone number, email, marital status, the preferred medical clinic
  • Military Service Information: last branch of service, last entry date, last discharge date, discharge type, military history
  • Insurance information: name of the health insurance company, name of the policy holder, policy number, group code, Medicaid eligibility
  • Dependent information: personal information about the spouse and children
    Gross annual income of the previous calendar year (this section and the two following are completed only if necessary)
  • Deductible expenses of the previous calendar year
  • Previous calendar year net worth

What do I do with the application after its completion?

The veteran can submit the form electronically at the VA’s site or forward it to the Health Eligibility Center, 2957 Clairmont Road, Suite 200, Atlanta, GA 30329.

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NGB Form 34 1: All You Need to Know About the AGR Position Application

United States military service members can get employed with the Active Guard Reserve (AGR) program if there is an open position corresponding with their job preferences. When starting the application process, the applicant must be ready to go through a thorough selection procedure and deal with strong competition. Having found the relevant position, the primary thing the applying service member should do is prepare the application document packet, including application NGB Form 34 1. In this blog post, we will figure out how to properly fill this form out.

Who should fill out NGB Form 34 1?

A soldier wishing to become a candidate for a vacant position in the Active Guard/Reserve (AGR) Program should file this form in order to be considered for an open position.
There are several requirements that must be met:

  • The applicant should be in a Ready Reserve status;
  • If the applicant is a part of the Regular Army, such a soldier should accept discharge from the Regular Army with concurrent appointment;
  • The applicant must be for at least 18, but not older than 55 years old.
  • The candidate must meet all health requirements for the position and have passed the necessary medical examination.

What is NGB Form 34 1 for?

This form is used to provide information required in determining eligibility and qualifications for Active Guard/Reserve positions. A copy will be provided to the soldier. The original will be kept by the Human resources Office for State records. All information that is disclosed in this form is given voluntarily. However, if it is not provided, you will not be accepted into the AGR program.

Is NGB Form 34 1 accompanied by other forms?

A Letter of Recommendation is required for all E4 corporals and only E5 sergeants with less than a one-year period in grade. The letter must be completed by the first O4 officer or higher in your chain of command and be submitted as an accompaniment to your NG 34-1 form.
The application form NG 34-1 always requires a list of attachments that may vary depending upon the particular case. The usual attachments that should be included can be found in this document.

How do I fill out Form NG 34-1?

The following information should be provided in order to complete this form:

  • Number of position announcement and position title;
  • Applicant’s personal information;
  • Information on education and special qualifications;
  • Employment history;
  • Military history.

Also, this form contains a personal background questionnaire that should be answered before signing the form.

Where do I send the completed form?

The filled out application form NG 34-1 and all the required attachments must be directed to the Human Resources Office (HRO) in the department that posted the job announcement before the indicated deadline.

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How to Reimburse the Medical Expenses with CMS 1500 Form

CMS 1500: Health Insurance Claim Form

The health insurance system of the USA consists of programs that help individuals pay for medical services provided during their stay in the hospital. This program can be private or funded by the government. The two most well known government insurance programs are Medicare and Medicaid. Actually, these are the basic insurance programs for the USA residents without any health insurance. With time, however, these programs became the standard for health insurance providers. The main point of any insurance program is to return the money spent on medical services. The patient in the hospital shows his health insurance policy to the physician, allowing medical coverage to be provided. After this, the health care provider should take the matter into his own hands. The first step for doing this is to gather all the required information about the medical charges is dealt with. The Centers for Medicare and Medicaid Services have a special document for this purpose – the CMS 1500 form 2015. Read below to learn more.

Who needs a CMS 1500 form 2015?

The Health Insurance Claim form is used by the health care providers to claim for the reimbursement for the services provided to the patients from the government health insurance programs. This form is issued by the Centers for Medicare and Medicaid Services.

What is the purpose of the CMS 1500 form 2015?

This claim form is required to receive payments from the Medicare and Medicaid carriers for the provided services. The physicians and sometimes private insurers complete the claim, indicating the information about the patience and his condition, medical services, and the insurance details.

What other documents must accompany the CMS 1500 form 2015?

Usually, this claim form doesn’t need to be supported by other documents.

When is the CMS 1500 form 2015 due?

The health care provider must file the claim form during the year after the medical services were provided.

What sections should be filled out in the CMS 1500 form 2015?

The physician or other authorized people must add the following details:

  • Type of the insurance (Medicare, Medicaid, Tricare, or other);
  • Information about the patient and the insured (name, address, birth date, sex, insured’s ID number, account number);
  • Information about the insurance (policy group, plan name or program name, health benefits name);
  • Information about the illness (date of the illness, injury or pregnancy, dates of the patient unable to work, hospitalization date, diagnosis or nature of illness or injury);
  • Information about the health care provider (name or referring provider or other sources);
  • Information about the medical services (dates, place, description of procedures, services, or supplies, charges);
  • Federal Tax ID number.

The Health Insurance Claim form must be signed by the patient or insured person and by the physician as well (including degrees or credentials).

Where the CMS 1500 form 2015 should be sent?

The completed claim form is forwarded to the Centers of Medicare carriers.