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DD Form 877 — a Department of Defense document. Title of record: DD Form 877, Request for Medical/Dental Records or Information, September 1967. Stated purpose: Medical/Dental Records or Information, Request For. Edition date not stated; status not stated.
Prescribing authority: not stated. Proponent: not stated. Unlike service-specific publications, DD forms carry Department-level authority and apply across the Army, Navy, Air Force, Marine Corps, Space Force and Coast Guard when operating under Defense jurisdiction.
The form reaches military personnel across the services, civilian employees of the Department, and the personnel and records specialists who receive it.
Timing of submission is fixed by not stated and by the implementing guidance of the submitting organization. What follows describes the blank document, not agency procedure.
Available formats: PDF. The form runs 1 pages and contains approximately 63 fillable fields.
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.
Free download applies to every format listed. Any current pdf reader opens the pdf files, though field behaviour is most reliable in a full desktop reader rather than a browser preview.
What the form asks for
- Item 16. Remarks. Mark one. Press space bar
- Date.
- 1. Patient (last name, first name, middle name).
- 2. Organization and place of treatment.
- 3. Status. Press space bar to mark X in first box if military second box if VA beneficiary, third box if dependent, fourth box if Federal employee, or fifth box if other.
- 3. Specify other status.
- 3. a. Name of sponsor, if dependent.
- 5. Identifying information. a. Service number.
- 5. b. Grade/rate.
- 5. c. Social security number. Do not include dashes.
- 5. d. V. A. claim number.
- 5. e. Date of birth, if federal employee.
- 6. Dates of treatment, inclusive.
- 7. Disease or injury.
- 8. a. Records requested. Clinical. Mark X if Military.
- 8.a. Clinical records requested. Mark X if V.A.
- Item 8. a. Records requested. Outpatient. Mark X if military.
- 8.a. Outpatient records requested. Mark X if V.A.
- 8. b. Records forwarded - Clinical. Mark X if military.
- 8.b. Clinical. Mark X if V.A.
- 8. b. Records forwarded. Outpatient. Mark X if military.
- 8.b. Outpatient. Mark X if V.A.
- 8. a. Records requested. Health record. Mark X if Military.
- 8. a. Records requested. Dental record. Mark X if military.
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.
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.
Cross-referenced forms are found through the numbering system. The DD sequence is Department-level and unified, which means a number cited on the page identifies one document across the whole Department.
A DD number and a DA number may appear in the same instruction without being related. DA forms belong to the Army alone; DD forms belong to the Department and are administered at Department level. The sequences are independent.
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?
- DD Form 877, Request for Medical/Dental Records or Information, September 1967
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?