Medical Treatment Records National Archives, DD Form 877 Instructions The DD Form 877 is the only request form that NPRC will accept from Military Treatment Facilities MTFs for retired clinical and medical treatment records This form is authorized for use by military facilities ONLY Do not distribute to individuals for personal use Follow the instructions below to complete the form . DD877 1 Executive Services Directorate, FORM INFORMATION Form Number DD 877 1 Title Request for Medical Dental Records from the National Personnel Records Center NPRC St Louis Missouri Edition Date 04 01 1998 Authority AR 40 66 Navy 23 54 AFR 168 4 For use of this form please contact The Department of the Army
.Dd Form 877 1
Dd Form 877 1
Medical Treatment Records National Archives
DD Form 877 Instructions The DD Form 877 is the only request form that NPRC will accept from Military Treatment Facilities MTFs for retired clinical and medical treatment records This form is authorized for use by military facilities ONLY Do not distribute to individuals for personal use Follow the instructions below to complete the form .
span class result type PDF span DD FORM 877 SEP 67 Navy Medicine
Complete Items 1 through 10 Except 8b also complete Item 19 REQUESTING ACTIVITY WILL ENTER COMPLETE ADDRESS TO WHICH RECORDS OR FINAL DD FORM 877 SEP 67 REPLACES EDITION OF 1 JAN 60 USAPPC V1 00 WHICH MAY BE USED Title DD Form 877 Request for Medical Dental Records or Information September 1967.
https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd0877.pdf
REPLACES EDITION OF 1 JAN 60 WHICH MAY BE USED DD FORM 877 SEP 67 CUI when filled in CUI when filled in REQUEST FOR MEDICAL DENTAL RECORDS OR INFORMATION REQUESTING ACTIVITY Complete Items 1 through 10 Except 8b also complete Item 19 ADDRESSEE Complete Items 8b 11 to 14 or 15 to 18 as appropriate
https://www.archives.gov/personnel-records-center/agencies/clinical-and-treatment-records
DD Form 877 Instructions The DD Form 877 is the only request form that NPRC will accept from Military Treatment Facilities MTFs for retired clinical and medical treatment records This form is authorized for use by military facilities ONLY Do not distribute to individuals for personal use Follow the instructions below to complete the form
Medical Records Request For Information TRICARE
To request a copy of your medical record fill out a DD Form 2870 Authorization for Disclosure of Medical Information You may submit your request in person at the front desk of the Medical Record Customer Service desk or fax your request Military treatment facilities must fax or mail a DD Form 877 To request records from a previous .
span class result type PDF span Dd Form 877 Sep 67 Eg Tricare
Dd form 877 sep 67 eg replaces edition of 1 jan 60 usappc v1 00 which may be used 3a name of sponsor if dependent other specify 1 patient last name first name middle name 2 organization and place of treatment a service number b grade rate c social security account no d va claim number .
span class result type PDF span L I Tricare
1 PATIENT Last Name First Name Middle Name 3 sTATus 0 MILITARY 0 VA BENEFICIARY 0 DEPENDENT JFEDERAL EMPLOYEE 2 ORGANIZATION AND PLACE OF TREATMENT OTHER Specify 3a NAME OF SPONSOR Ifdependent 4 TO Include ZIPCode DD FORM 877 SEP 67 EG REPLACES EDITION OF 1 JAN 60 USAPPC V1 00.
DD Form 877 1 Request for Medical Dental Records from the National
DD Form 877 1 Request for Medical Dental Records from the National Personnel Records Center NPRC St Louis Missouri is used to request medical and dental records from the National Personnel Records Center NPRC located in St Louis Missouri This form is crucial for obtaining medical and dental records for individuals who were part of the armed forces .
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