DD Form 2871 Request to Restrict Medical or Dental Information

DD Form 2871 Request to Restrict Medical or Dental Information

What Is DD Form 2871?

This is a form that was released by the U.S. Department of Defense (DoD) on December 1, 2003. The form, often mistakenly referred to as the DA Form 2871 , is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DoD.

FAQ

Q: What is DD Form 2871?
A: DD Form 2871 is a document used to request the restriction of medical or dental information.

Q: What is the purpose of DD Form 2871?
A: The purpose of DD Form 2871 is to request the restriction of medical or dental information to protect privacy.

Q: Who can use DD Form 2871?
A: Anyone who wants to restrict their medical or dental information can use DD Form 2871.

Q: What information can be restricted using DD Form 2871?
A: DD Form 2871 can be used to restrict any medical or dental information that you do not want to be disclosed to certain individuals or organizations.

Q: Is there a cost to submit DD Form 2871?
A: No, there is no cost to submit DD Form 2871.

Q: How long does the restriction on medical or dental information last?
A: The length of the restriction on medical or dental information can vary, but it is typically valid for one year.

Q: Can the restriction be lifted before the expiration date?
A: Yes, you can request to lift the restriction before the expiration date by submitting a new DD Form 2871.

Q: Who can access the restricted medical or dental information?
A: Only authorized individuals or organizations who have a legitimate need to know can access the restricted medical or dental information.

Q: What should I do if I have concerns about the privacy of my medical or dental information?
A: If you have concerns about the privacy of your medical or dental information, you should consult with the appropriate military or healthcare personnel for guidance.

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Form Details:

  • A 2-page document available for download in PDF;
  • The latest version available from the Executive Services Directorate;
  • Editable, printable, and free to use;
  • Fill out the form in our online filing application.

Download an up-to-date fillable DD Form 2871 down below in PDF format or browse hundreds of other DoD Forms compiled in our online library.

Download DD Form 2871 Request to Restrict Medical or Dental Information

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