Download the form
Department of Defense form 2876-1. Official designation: DD 2876-1, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form. Purpose: TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (EAST). Current edition not stated, status not stated.
Governing directive: not stated. Responsible office: not stated. The DD designation signals joint scope — all military departments, combatant commands and defense agencies draw on a single edition of the document.
Common users: service members regardless of branch, Defense civilian staff, and the offices that file, verify or retain the finished document.
Submission follows the schedule set by not stated and by local implementing procedures. This page provides the blank form for download and general orientation only.
The download set covers PDF. Document length is 5 pages with about 152 entry fields.
Distribution centres on pdf. Two states exist: fillable, where field boxes accept keyboard input and retain it, and printable, a static blank produced for manual completion. Typed data reproduces cleanly across copies; handwritten data depends on the writer.
The xfdl release corresponds to IBM Lotus Forms. This format carried Department-wide form distribution for years and opens only in IBM Lotus Forms Viewer or a compatible client, not in a pdf reader.
Every listed format is free to download. Modern pdf software handles the pdf files, with the caveat that browser-embedded viewers sometimes ignore field properties that a desktop reader honours.
What the form asks for
- Contractor's website.
- TRICARE Prime option desired. Press space bar to mark X in first box if TRICARE Prime, second box if TRICARE Prime Remote, third box if TRICARE Overseas Program Prime, or fourth box if Uniformed Services Family Health Plan.
- Section I - Sponsor information. 1. Sponsor name (last, first, middle initial) (must match DEERS).
- Sponsor's social security number or DoD Benefits Number (DBN).
- 3. Sponsor is: X first box if active duty, second box if retired, third box if deceased, or fourth box if unremarried former spouse.
- 4. Sponsor's work telephone number (include area code/extensions).
- 5. Sponsor's email address.
- 7. Sponsor's residence address (street, apartment number, city, state, zip code, country).
- X if new address.
- 8. Sponsor's mailing address (provide APO or FPO if stationed overseas).
- X if same as residence address.
- X if new address.
- 9. Sponsor's military assignment. a. Unit.
- b. Unit identification code (if known).
- c. State, zip code and country of work address.
- 10. Requested action. X first box if none for sponsor (go to section II - family), second if enroll, third if transfer enrollment, fourth if PCM change, or fifth if disenroll.
- 11. Sponsor primary care preference. a. PCM, first choice. X first box if military treatment facility, second box if PRP (active duty only), third box if civilian.
- Primary care manager full name or MTF/clinic.
- b. Second choice. X first box if military treatment facility, second box if civilian.
- Primary care manager full name or MTF/clinic.
- c. PCM specialty. X first box if no preference, second box if family/general practice, third if internal medicine, or fourth if flight medicine.
- d. Preferred PCM gender. X first box if no preference, second box if male, third box if female.
- Section II - Enrolling family members. 12.a. First family member name (last, first, middle initial) (must match DEERS).
- b. Date of birth (4 digit year, 2 digit month, 2 digit day).
Completion runs in the order printed on the page: identifying data at the head, the body of the entry next, certification at the foot. Header data frequently governs what belongs in the fields below it.
Edition in use: not stated. Because DD forms are revised at Department level and distributed to all services at once, an obsolete printing may not match the fields an office expects. The date is printed on the form face.
Guidance for specific entries sits on the form face and in not stated; the directive is authoritative where the two do not agree.
Once executed, routing follows not stated and the submitting organization's own instruction. Keeping a copy is standard.
Related documents are located by series and number. DD forms sit in a single Department-wide sequence, so a form referenced inside DD Form 2876-1 is normally found by its number alone, without regard to service.
Where a DA form is cited alongside a DD form, the two belong to different systems: DA numbering is Army-specific and administered by an Army proponent, while DD numbering is Defense-wide under not stated or an equivalent Department office. Numbers do not translate between the systems.
Forms are reissued for several reasons: directive revision, changed data requirements, updated notice language. Confirming not stated at the moment of download covers the risk.
The material here is descriptive. Nothing on the page constitutes legal or procedural advice, and no statement here determines whether a submitted form will be accepted. Such questions go to not stated, a servicing administrative office, or the authority identified in not stated.
Questions and answers
- What is DD Form 2876-1?
- DD 2876-1, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?