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Patients and non-active duty Non-Medical Attendants (NMAs): Complete both forms.The form must be completely filled out and signed.

Active duty NMAs: Complete only the DD Form 1351-2.

View the Instructions and Examples for help completing the DD 1351-2 form.

Include legible, itemized receipts for all travel claims.Credit card or bank statements don't qualify as receipts.Receipts must be dated during the approved travel timeline or they won't be reimbursed.

Proof that you Attended the Appointment FormĪ note from the Specialty Care Specialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide. provider's office verifying that you attended the appointment or submit the DHA 126 Form. (Needed for adult patients who are 18 years or older)Ī letter from your doctor stating that a non-medical attendant (NMA) is appropriate and medically-necessary. You must file your travel claim within one year of the travel date.įor chronic conditions, the doctor may request the letter be valid for up to one year.Īll payments are made by electronic funds transfer (EFT). Send all required documents via email, fax or mail.

FontViewOK 8.38 instal the new version for iphone