BENEFICIARIES

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Beneficiary Forms


Find all the forms you need to take care of your TRICARE®  business.

 

Appointment of Representation (For appeals only -be sure to include your reconsideration/appeal request)

HIPAA Authorization for Disclosure Form (DD2870) 

Beneficiary Claim Form (DD2642)
Other Health Insurance Questionnaire (Please note: As a myTRICARE Secure member, you can update OHI online.)

Privacy Complaint Form

Request to Restrict Protected Health Information

Statement of Personal Injury / Third Party Liability (DD2527)

TRICARE Prime application and PCM Change form 

Enrollment Fee Allotment

 

Some of these forms are in Adobe Acrobat PDF format. To view or print, you will need the Adobe Acrobat Reader.



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