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.
