Dd Form 1907 Example DD Form 2138 JAN 78 REPLACES AF FORM 275 MAR 71 WHICH IS OBSOLETE REQUEST FOR TRANSFER OF OUTPATIENT RECORD THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974 Use Blanket PAS DD FORM 2005 This form may be used only when requesting records from US Military Medical and Dental facilities
DD Form 2138 DD Form 2569 DD Form 2870 Defense Health Agency Forms DHA Form 236 Pediatric 6 months 11 years COVID 19 Vaccine Screening and Immunization DHA Form 207 COVID 19 Vaccine Screening and Immunization Document TRICARE Forms Download a TRICARE Form DD FORM 2813 NOV 2021 CUI when filled CUI when filled Controlled by DHA CUI Category PRVCY LDC FEDCON PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION PRIVACY ACT STATEMENT AUTHORITIES Public Law 104 191 Health Insurance Portability and Accountability Act of 1996 10 U S C Chapter Ch 55 Medical and Dental Care 10 U S C
Dd Form 1907 Example
Dd Form 1907 Example
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U S Government PDF Forms Fillable And Printable
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https://womack.tricare.mil/Portals/152/Document/dd2138.pdf
DD Form 2138 JAN 78 REPLACES AF FORM 275 MAR 71 WHICH IS OBSOLETE REQUEST FOR TRANSFER OF OUTPATIENT RECORD THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974 Use Blanket PAS DD FORM 2005 This form may be used only when requesting records from US Military Medical and Dental facilities
https://womack.tricare.mil/Patient-Resources/Forms
DD Form 2138 DD Form 2569 DD Form 2870 Defense Health Agency Forms DHA Form 236 Pediatric 6 months 11 years COVID 19 Vaccine Screening and Immunization DHA Form 207 COVID 19 Vaccine Screening and Immunization Document TRICARE Forms Download a TRICARE Form
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DD Form 500 999 DD Form 1000 1499 DD Form 1500 1999 DD Form 2000 2499 DD Form 2500 2999 DD Form 3000 3499 Other Forms Secretary of Defense SD Forms ODA M Forms Washington Headquarters Services WHS Forms Standard Forms SF Optional Forms OF Forms Cancellations Forms Policy Forms Management Program DODM 7750 08 DoD Forms Military medical facilities may request transfer of medical records using DD Form 2138 or other approved form Last Updated 12 3 2020 Don t forget to keep your family s information up to date in DEERS Brian D Allgood Army Community Hospital Bldg 3030 Bldg 3031 Indianhead Ave USAG Humphreys
Download Fillable Dd Form 2138 In Pdf The Latest Version Applicable For 2024 Fill Out The Request For Transfer Of Outpatient Record Online And Print It Out For Free Dd Form 2138 Is Often Used In Request For Transfer Transfer Request Form U s Department Of Defense United States Federal Legal Forms Legal And United States Legal Forms DD Form 2138 titled Request for Transfer of Outpatient Records is used by medical facilities within the Department of Defense to request the transfer of outpatient medical records from one facility to another The form consists of sections where users enter details about the patient the sending and receiving facilities the reason for transfer and necessary medical
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If you received a DD form 877 or DD form 2138 from your previous duty station please email to Medical Records at usarmy novosel medcom lahc list release of information health mil Step 4 DD Form 2138 is used to request the transfer of outpatient medical records from one military treatment facility MTF to another Learn how to fill out mail and file the form and when to provide copies or extracts of the records
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Figure 2 2 DD Form 1907 Signature And Tally Record
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Dd Form 1907 Example - Download Fillable Dd Form 2138 In Pdf The Latest Version Applicable For 2024 Fill Out The Request For Transfer Of Outpatient Record Online And Print It Out For Free Dd Form 2138 Is Often Used In Request For Transfer Transfer Request Form U s Department Of Defense United States Federal Legal Forms Legal And United States Legal Forms