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This form is used to prescribe eyewear and collect necessary patient and order information for the production of glasses or contact lenses.
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How to fill out dd form 771
How to fill out DD Form 771
01
Obtain a copy of DD Form 771 from the official Department of Defense website or appropriate authority.
02
Begin by filling out Section I, providing personal information such as name, rank, and service number.
03
In Section II, indicate the type of treatment received and the date of examination.
04
Fill out Section III, detailing the specific needs for eyewear or other corrective devices.
05
If applicable, have a healthcare provider complete Section IV, which includes their signature and information.
06
Review the form for accuracy and completeness.
07
Submit the completed DD Form 771 to the relevant military healthcare provider or designated office.
Who needs DD Form 771?
01
Active duty military personnel requiring eyewear or corrective devices.
02
Reservists and National Guard members who need a prescription for glasses or contact lenses.
03
Veterans seeking to document their optical health needs.
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What is dd form 771?
DD FORM 771, JUL 96 These questions help us understand your eye health & vision needs prior to deployment. IF THIS FORM IS NOT PROPERLY COMPLETED AND SUBMITTED TO OUR MEDICAL TEAM A MINIMUM OF 15 DAYS PRIOR TO YOUR ARRIVAL, YOUR DEPARTURE WILL BE DELAYED. IT TAKES A MINIMUM OF 10 DAYS FOR EYEWEAR TO ARRIVE.
What is an example of a prescription for astigmatism?
The report of separation form issued in most recent years is the DD Form 214 (dd214, dd 214, dd-214, dd form 214), Certificate of Release or Discharge from Active Duty.
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What is DD Form 771?
DD Form 771 is a form used by the Department of Defense to document an eligible beneficiary's request for vision care services and eyewear.
Who is required to file DD Form 771?
Eligible military beneficiaries who seek vision care services or require eyewear are required to file DD Form 771.
How to fill out DD Form 771?
To fill out DD Form 771, provide the required personal information, including the patient's identification data, and details regarding the vision care request, ensuring all sections are completed accurately.
What is the purpose of DD Form 771?
The purpose of DD Form 771 is to facilitate the processing of requests for vision care and to ensure that eligible beneficiaries receive the necessary eyewear and optical services.
What information must be reported on DD Form 771?
DD Form 771 must report personal information of the beneficiary, the nature of the vision care request, any specific eyewear needs, and the prescribing provider's information.
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