DEPLOYED MEDICAL RECORD REQUEST INSTRUCTIONS
DD 2870 - Authorization for disclosure of medical or dental information, Dec. 2003
In order to facilitate the release of medical records, PASBA will follow this procedure:
Requesting a copy of the medical record
1. PASBA will first verify if the medical record is in their possession.
2. If the record is in PASBA's custody, the requestor must complete DD Form 2870 (Authorization for Disclosure of Medical or Dental Information) and have the Service Member sign the form authorizing release of medical information. The requestor must provide detailed information describing specifically what information is being requested and why that information is needed, (i.e. UCMJ, Medical Board Processing, Separation Processing), particularly if the Service Member refuses to sign the request.
In addition, specify exactly what episode of care the request is for.
3. Once PASBA receives the signed authorization form, the PASBA Information Assurance (IA) Coordinator will review and verify the authenticity of the request and identity of the requestor as the patient owner of the record. After all requirements are fulfilled, the IA coordinator will approve to copy the record. PASBA will duplicate the medical record and mail the duplicate to the Service Member. A copy of DD Form 2870 will be placed in the Service Member's medical record documenting this action.
4. The Requestor may be directed to contact NPRC in the event that the Medical Record has been retired. The Requestor may also be directed to the military treatment facility they were seen at in theater if PASBA has no record of receiving the medical record.
5. Ft. Sam Houston SJA will review all medical records request from outside entities. Once SJA has approved this request, PASBA will duplicate the medical record and mail the duplicate to the requesting party. A copy of DD Form 2870 will be placed in the Service Member's medical record documenting this action.
Purpose
PASBA receives all Inpatient Records from deployed medical units that do not have access to the Composite Health Care System (CHCS) once that unit returns from theater. PASBA reviews, performs data quality checks, codes, enters the record information into a number of databases and then forwards them to the National Personnel Records Center (NPRC) in St. Louis, Missouri for retirement.
AR 40-66
Army Regulation 40-66, Chapter 2 explains DA policies and procedures governing the release of medical information or medical records pertaining to individual patients. DA policy mandates that the confidentiality of patient medical information and medical records be protected to the fullest extent.
Procedure
There may be instances when the patient or other agency (Staff Judge Advocate (SJA) Officer, soldier's Commander, MTF's Case Worker, etc.) requires copies of the medical records from deployments. Because the inpatient record is only at PASBA for a short time, there is a possibility the record may not be at PASBA when the request is made. PASBA will follow the above stated procedure (Requesting a copy of the medical record).
For requests, problems, or assistance contact:
Information Assurance Coordinator, (210) 221-1414 DSN: 471
E-Mail Address: Record.Request@pasba2.amedd.army.mil
Fax Num. 221-0263 DSN 471
To suggest corrective action, Deputy Director, PASBA, (210) 295-9507 DSN: 421
E-Mail Address: Record.Request@pasba2.amedd.army.mil
Fax Num. 221-0579 DSN 471
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