Forms

Accessing TRICARE DD forms:

Due to security settings, you may not be able to view certain DD forms in your web browser. If you encounter an issue viewing a form in your web-browser, right-click and select "Save as" to save to your computer. You can then open the form using your system's default program for viewing PDFs. You can also try accessing the form directly from the official DoD forms site.

Claims

Appointment of representative

Claim form (DD2642)

Other Health Insurance (OHI) questionnaire

Public facility use certification form

Timely filing waiver

Third party liability claim form (DD2527)

Billing and Enrollment

Billing and Payment Options

Make a payment

Set up allotment

Set up recurring payment with bank account

Set up recurring payments with credit card

Log in to see your billing summary or make a payment

Enrollment Forms

Continued Health Care Benefit Program (CHCBP)

Prime enrollment, disenrollment and PCM change form (DD2876)

Select enrollment, disenrollment and change form (DD3043)

TRICARE Young Adult (TYA) application (DD2947)

HIPAA

General release of information authorization requests

General release of information authorizations should be completed online through beneficiary self-service. Sensitive diagnosis and revocation options are not available in self-service at this time.

Log in or register to submit a general release of information request.

Paper Submission Forms

Authorization for release of information form (general)

Authorization for release of information form (sensitive diagnosis)

Revocation of prior authorization

Miscellaneous

Red Hill

DHA’s Red Hill Public Health information page

Naval Health Clinic Hawaii Red Hill Clinic (for those on-island)

Email questions to dha.redhill@health.mil

Miscellaneous Forms

Case management referral form

COVID-19 Vaccine Screening and Immunization Documentation (DHA Form 207) 

TRICARE Resources

Costs

TRICARE Health Matters newsletters

TRICARE Newsroom

TRICARE Online

TRICARE Publications

Covered services

Quit tobacco

Your bill of rights

Last Updated 12/2/2024