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DD-2766, form DD-2766, U.S. NAVY form DD-2766, U.S. NAVY forms, U.S. NAVY documents, U.S. NAVY publications, PDF forms fillable savable, PDF forms fillable, ...
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How to fill out dd2766 form
Point by point guide on how to fill out DD 2766:
01
Ensure you have the correct form - DD 2766 is the form used for healthcare services utilization.
02
Start by entering your personal information in Section I. Include your name, rank, Social Security Number, and contact information.
03
Moving to Section II, provide your healthcare eligibility information, such as your insurance information and any other pertinent details.
04
In Section III, fill out the date and place where the healthcare service was provided. Include the name and address of the facility.
05
Next, in Section IV, describe the type of healthcare service received. Provide as much detail as possible, including the diagnosis, treatment, and any medications administered.
06
If there were additional providers involved in your healthcare, list them in Section V along with their contact information.
07
For Section VI, you need to calculate the total charges incurred for the healthcare service. This includes any deductibles or co-payments.
08
Section VII requires you to indicate whether you have insurance coverage and its specifics, such as the type of coverage and policy number.
09
Finally, in Section VIII, sign and date the form to certify that the information provided is accurate and complete.
Who needs DD 2766:
01
Active duty military personnel who received healthcare services in a military treatment facility or civilian facility under the TRICARE program.
02
Retired military personnel and their dependents who received healthcare services under the TRICARE program.
03
Reservists and National Guard members who received healthcare services during active duty orders or in conjunction with training exercises.
04
Dependents of military personnel who received healthcare services under the TRICARE program.
05
Veterans who received healthcare services in a Veterans Affairs (VA) facility or have health benefits through the Veterans Health Administration (VHA).
06
Civilian employees of the Department of Defense (DoD) and their dependents who received healthcare services under the TRICARE program.
Overall, anyone who received healthcare services through military health programs like TRICARE or the VA may require the use of DD 2766 to document and submit their healthcare utilization.
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