99f0b496e7 Forms Home DD Department of Defense Forms in Microsoft Word . . DD 877-1 Form: . 12. REMARKS REQUESTING ACTIVITY - ADDRESSEE - Complete Items 1 through 10 . DD Form 877, Request for Medical or Dental Records or Information, September 1967. Clinical and medical treatment records that were retired to NPRC prior to 2002 must be ordered by submitting DD Form 877 . medical treatment records . 12 /31/2013 . TOTAL YEARS GOVERNMENT 12. AGENCY (Non-Service Members Only) 13. ORGANIZATION UNIT AND UIC/CODE SERVICE a. MILITARY b. . 1-877-TRICARE (1-877-874-2273) . must use a TRICARE claim form (DD Form 2642 TRICARE DoD/CHAMPUS Medical Claim Patients Request for Medical Payment).
Dd Form 877 Pdf 12
Updated: Nov 25, 2020
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