DD Form 2870 Authorization for Disclosure of Medical or Dental Information December 2003-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section I - Patient Data. Enter your name, date of birth, and social security number accurately. Specify the period of treatment and select the type of treatment applicable.
3. In Section II - Disclosure, indicate the facility or TRICARE Health Plan you are authorizing to release your information. Fill in the name, address, and contact details of the physician or facility.
4. Select the reason for requesting your medical information by checking the appropriate boxes. Be sure to specify any additional information that needs to be released in the provided space.
5. Complete Section III - Release Authorization by signing and dating the form. Ensure you understand your rights regarding revocation and disclosure.

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