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NON-PARTICIPATING PROVIDER CLAIM FORM Please Print or Type PO Box 9091, Melville, NY 11747-9091, 1-800-426-5880 PATIENT AND INSURED (SUBSCRIBER) INFORMATION (READ INSTRUCTIONS BEFORE COMPLETING AND
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Start by carefully reading the entire army regulation 40-66 medical document. Familiarize yourself with the requirements, guidelines, and procedures outlined in the regulation.
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Gather all the necessary information and documentation needed to complete the form accurately. This may include personal identification information, medical history, current medications, and any relevant medical records.
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Begin filling out the form section by section, following the instructions provided. Pay close attention to any specific formatting or instructions given for each section.
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Ensure that all information provided is accurate and up to date. Double-check spellings, dates, and any other details to avoid any errors or mistakes.
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If there are any sections or questions that you are unsure about, seek clarification from a supervisor, healthcare provider, or the relevant authority responsible for army medical regulations.
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Who needs army regulation 40-66 medical?

01
Active-duty military personnel: Army regulation 40-66 medical applies to all active-duty military personnel in the United States Army. It includes regular Army personnel, as well as reservists and National Guard members on active duty.
02
Applicants and recruits: Individuals who are in the process of applying to join the United States Army must also comply with army regulation 40-66 medical. This ensures that all new recruits meet the necessary medical standards for military service.
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Army healthcare providers and administrators: Army regulation 40-66 medical serves as a guide for healthcare providers and administrators involved in the medical evaluation and examination processes of military personnel. It outlines the requirements and procedures they must follow to determine an individual's medical fitness for service.
Please note that the information provided is a general overview, and it is always recommended to consult the specific army regulation 40-66 medical document, relevant authorities, or healthcare professionals for complete and accurate guidance.
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Army Regulation 40-66 pertains to the Medical Records Administration and Health Care Documentation in the United States Army.
All active duty and reserve component service members are required to file Army Regulation 40-66 medical records.
To fill out Army Regulation 40-66 medical, service members must provide accurate and detailed information about their medical history, treatments, and current health status.
The purpose of Army Regulation 40-66 medical is to maintain accurate and up-to-date medical records for service members to ensure proper medical care and readiness.
Information such as medical history, treatments, surgical procedures, medications, allergies, and any other relevant health information must be reported on Army Regulation 40-66 medical.
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