DD Form 877

REQUEST FOR MEDICAL/DENTAL RECORDS OR INFORMATION


Requests from military medical facilities for health and/or clinical records are submitted on a DD Form 877.

General information:  Treatment facilities usually request the following types of records.


Core Employees:

General processing of the DD Form 877:

If requested information is available in the record:

  1. Complete the Reply/Referral section (blocks 11 through 14).
  2. Check the appropriate boxes regarding Records Forwarded (block 8b).
  3. Retain a copy of the completed form in the OMPF.
  4. Forward the completed DD Form 877, and copies of requested records to the requestorís address provided in block 19.

If the requested records are not at NPRC and their present location is unknown:  Inform the requestor that the requested records are not on file.  Check the appropriate box in block 12 of the DD877

If the requested records are not at NPRC and their present location is known (as shown in examples below).

  1. Inform the requestor of the location of the records.
  2. Retain a copy of the DD Form 877 in the OMPF.
    • Health record retired to the Department of Veterans Affairs (DVA) Records Management Center on or after the following dates:

      Air Force:May 31, 1994
      Army:October 16, 1992
      Navy:January 31, 1994
      Marine Corps:  May 1, 1994
      Coast Guard:April 1, 1998
    • Clinical record still at treating facility (clinical not yet retired to NPRC)
    • Health or clinical record loaned to VA.

OR Technicians:

General Information:  Request are from Medical Treatment facilities, often the treatment facility that retired the records to NPRC.  The Treatment Facilities usually request the following types of records.

General processing of the DD Form 877:

  1. Furnish original records.
  2. Complete the Reply/Referral section (blocks 11 through 14).
  3. Check the appropriate boxes regarding Records Forwarded (block 8b).
  4. Retain a copy of the completed form in the OMPF (if available) and the Clinical or Outpatient record.
  5. Forward the completed DD Form 877, and requested records to the medical treatment facility (only) address provided in block 19.

Source:  NPRC 1865.103