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Department of Defense form 877-1. Official designation: DD Form 877-1, Request for Medical/Dental Records from the National Personnel Records Center, April 1998. Purpose: Request for Medical/Dental Records from the National Personnel Records Center (NPRC) (St. Louis, Missouri). 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.
Users include uniformed members of any branch, DoD civilian employees, contractor personnel where authorized, and the administrative staff who process the completed record.
When the form is filed is a matter of not stated and local instruction. The description here covers the document itself and how to obtain a copy.
Available formats: PDF. The form runs 2 pages and contains approximately 63 fillable fields.
Pdf serves as the base format. In the fillable variant, each box is an interactive field that holds typed text inside the document. In the flat printable variant, no fields exist — the page prints as a blank to be completed by hand. Typed entries survive transmission; handwriting does not always survive scanning.
What the form asks for
- 1. Request date (4 digit year, 2 digit month, 2 digit day).
- 2. Patient's name at time of treatment (last, first, middle).
- 3. Year of treatment (1st digit).
- 3. Year of treatment (2nd digit).
- 3. Year of treatment (3rd digit).
- 3. Year of treatment (4th digit).
- 4. Name of facility where patient was treated.
- 5. Disease or injury.
- 6. Status at time of treatment. Press space bar to mark X in first box if military, second box if retired military, third box if dependent, fourth box if federal employee, or fifth box if other.
- 7. Identifiers. a. If Military. (1) Social Security number.
- 7.a. (2) Service number, if applicable.
- 7.a. (3) Branch of service (at time of treatment).
- 8. Type of treatment. X first box if inpatient, second box if health record, third box if dental, fourth box if psychiatric/consultation.
- 7. Identifiers. b. If Retired Military. (1) Social Security number.
- 7.b. (2) Service number, if applicable.
- 7.b. (3) Branch of service (at time of treatment).
- 7.b.(4) Date retired (4 digit year, 2 digit month, 2 digit day).
- 8. Type of treatment. X first box if inpatient, second box if outpatient, third box if dental, fourth box if psychiatric/consultation.
- 7. Identifiers. c. If dependent: (1) Sponsor's Social Security number.
- 7.c.(2) Sponsor's name (last, first, middle initial).
- 7.c. (3) Other dependent information.
- 8. Type of treatment. X first box if inpatient, second box if outpatient, third box if dental, fourth box if psychiatric/consultation.
- 7. Identifiers. d. If Federal Employee or e. Other. (1) Social Security number.
- 7.d. (2) 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.
Verify the edition date against not stated before entry. Department-level revisions replace the blank across every service simultaneously, so an old copy in a desk drawer may no longer correspond to current field numbering.
Field-level instructions appear on the form itself and in not stated. The directive is the controlling text.
After completion, the copy goes to the office designated by not stated or by local procedure. Retention of a personal copy is ordinary practice and costs nothing.
Associated forms are traced by number within the series. Because the DD sequence is common to all military departments, no service qualifier is needed to identify a referenced form.
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.
Scope of this page: distribution of a published form and description of its contents. It offers no legal guidance and no assurance regarding any particular submission. Direct procedural questions to not stated, to the servicing personnel office, or to the office designated in not stated.
Questions and answers
- What is DD Form 877-1?
- DD Form 877-1, Request for Medical/Dental Records from the National Personnel Records Center, April 1998
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?