Miscellaneous Forms Requesting Copies of Medical Records - Form Instructions DD FORM 2870 - Third Party Authorization For Disclosure of Information - Form Instructions DD FORM 2569 - Third Party Collection Program/Medical Services Account/Other Health Insurance Medical Records General Information The Medical Records Department is located across from the Lab, where medical records for active duty personnel, dependents, and retirees who receive their care at Fox Army Health Center are maintained. As a general rule, medical records are “retired” two years after the patient’s last treatment date and sent to the National Personnel Record Center, St. Louis, Missouri. Service Treatment Records (STRs), which are medical records that belong to active duty personnel, are retired to the AMEDD Records Processing Center (ARPC). At the ARPC, the STRs are uploaded into the electronic medical record section called HAIMS, which can be viewed by Veteran’s Administration personnel. The Medical Records Department at Fox Army Health Center is under a "Closed Medical Record System". This means that patients are not allowed to hand carry their medical records. Patients are entitled to one free copy of their medical record/information; however, there is a charge for additional record copies. In accordance with the Health Insurance Portability and Accountability Act (HIPAA) and Alabama State Law, parents and guardians are prevented from obtaining medical information, copies of medical records, etc., of their minor children aged 14 years and older without that minor’s written authorization. In some instances, though rare, the age can be younger than 14 years. In accordance with HIPAA, if a patient aged 14 years and above wishes another person (i.e., parent, spouse, etc.) to obtain their medical information, written authorization is required. DD Forms 2870, Authorization for Disclosure of Medical or Dental Information. Follow the instructions for Completing DD Form 2870, Third Party Authorization. View more information on HIPAA Compliance within the MHS, visit: https://www.health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties/HIPAA-Compliance-within-the-MHS. Patients are advised to come by the Medical Records Department Section when they first in-process to Fox Army Health Center so we may ensure we have the correct information on file for you. This is also where patients complete the DD Form 2569, Third Party Collection Program/Medical Services Account/Other Health Insurance Form (access DD FORM 2569) and obtain the Fox Army Health Center Medical Insurance Verification Card. All patients (excluding those who are active duty) will be asked to present this card prior to each appointment and prior to receiving x-rays, lab work and/or medications from the Pharmacy (this includes all children). The DD FORM 2569 must be completed once a year at a minimum, or any time there is any change in your medical insurance information. For additional information about other health insurance, please reference the Third Party Collection Program listed below. Release of Information and Requesting Copies of Medical Records All releases or transmittals of medical records, information and preparation of copies of these documents (i.e., personal copies, civilian provider requests, insurance requests, legal requests and VA and Disability requests) are provided through the Medical Records Department. Please allow 30 business days for each complete record copy requested to be delivered. All record copies will be delivered via DODSAFE (email), unless specified otherwise. Patients are entitled to one free copy of their medical record/information. There is a charge for additional copies. To request a copy of your medical records, complete DD Form 2870. Follow the Instructions for Completing Authorization Forms to Request Copies of Records. Telephone and Operating Hours Operating Hours: 0800-1500, Monday - Friday, open during lunch hours, unless otherwise posted. Telephone for Medical Records Department: (256) 955-8888, Extension 1044. Telephone for Release of Medical Information/Requesting Copies of Records: (256) 955-8888, Extension 1043. Telephone for the PAD PEBLO (Active Duty Medical Issues and Boards) office: (256) 955-8888, Extension 1045. Telephone for the onsite VA Representative: 334-213-3491. Travel Reimbursement For information regarding Travel Reimbursement. The Third Party Collections Program Frequently Asked Questions (FAQs) The Consolidation Omnibus Reconciliation Act of 1986 (COBRA) established the Third Party Collection Program. Under this program military medical treatment facilities are authorized and obligated to bill health insurance carriers (like Blue Cross or Mail Handlers) for the cost of medical care furnished to retirees and family members who are covered by insurance policies. Fox Army Health Center (FAHC) must comply with this law and we need your help to make the program successful. We will ask if you have health insurance by completing the Third Party Collection Program/Medical Services Account/Other Health Insurance (access DD FORM 2569) when you are seen in any one of our outpatient clinics or ancillary services (Pharmacy, Radiology and Lab). Under the law, we are required to determine if the Government's cost of your care can be recovered from companies providing group and individual health insurance. If you are covered by a health insurance policy, or if you are a member of an HMO (such as Humana or Complete Health), we will need your insurance information. This includes Medicare Supplemental policies, which we are authorized to bill as of 1 April 2000. The obligation to pay medical care cost applies only to the insurance carrier. You will not be sent a bill for amounts not covered by the insurance carrier. Your insurance company will pay benefits directly to FAHC and you will NOT be billed for any uncollected charges. If you have a deductible and you are seen at any military treatment facility, the government will absorb your insurance deductible. This will save you money should you need civilian care outside, by meeting your deductible first. MONEYS COLLECTED UNDER THIS PROGRAM GO DIRECTLY TO FOX ARMY HEALTH CENTER TO PROVIDE ENHANCED HEALTH CARE SERVICES TO YOU - THE PATIENT. In most cases, FAHC is no different than other health care providers who need insurance information. To collect benefits covered by your health insurance, we must have the information that appears on your health insurance identification card. PLEASE have this card with you every time you use this facility. Your cooperation will be greatly appreciated. Telephone information to contact the Third Party Office, is Direct Lines (256)955-0403 or (256) 876-4464. The Physical Disability Evaluation System (PDES) All soldiers run the risk of having their military careers ended prematurely when serious illness or injury strikes. On a daily basis, active duty (AD) soldiers are injured. Some occur during training accidents and field exercises; others in auto/motorcycle accidents and slip and fall incidents during off duty time. This includes Reserve Component (RC) soldiers as well, with peacekeeping operations and extended deployments. Soldiers and family members should be familiar with the Army PDES; it covers most situations. AD soldiers are covered 24 hours a day and the RC members are covered during Annual Duty for Training (ADT), Individual Duty for Training (IDT), or other authorized military activities. A soldier can be referred into the PDES one of five ways: Medical Evaluation Board (MEB) When a soldier has reached optimal care for a condition which may render him/her below medical retention standards IAW AR 40-501, Chapter 3, Standards of Medical Fitness, the soldier is recommended for a MEB under the provisions of AR 40-400, Chapter 7, Patient Administration. The military treatment facility (MTF) initiates the MEB and refers the case to the Physical Evaluation Board (PEB) as applicable for a determination of fitness under the policies and procedures of DODI 1332.38/39 and AR 635-40, Physical Evaluation for Retention, Retirement, or Separation. Military Occupational Specialty (MOS)/Military Medical Retention Board (MMRB) The MMRB is an administrative board conducted under the provisions of AR 600-60, Physical Performance Evaluation System. It determines whether the soldier's permanent 3 or 4 profile hinders him/her from performing their primary MOS in a worldwide field environment. Referral to the MEB is one of four actions the MMRB Convening Authority (MMRBCA) may direct. Fitness for Duty Medical Examination Commanders may refer soldiers to the MTF for a medical examination under the provisions of AR 600-20, Chapter 5-4, if the Commander believes the soldier has a medical condition which impacts his/her duty performance. If the exam indicates the soldier falls below the retention standards of AR 40-501, the soldier is recommended for referral to the MEB. HQDA action Upon recommendation of the Surgeon General, the Commander, Human Resources Command (HRC), may refer a soldier to the responsible MTF for a medical evaluation, as described in paragraph 3 above. The Commander, HRC may also direct a soldier into the PDES upon disapproving the MMRBCA’s recommendation to reclassify or branch transfer a soldier. RC Nonduty Related Process RC members not on active duty pending separation for nonservice-connected illnesses or injuries may be referred to the PEB, by the United States Army Reserve Regular Reserve Component (USAR RRC)or the Army National Guard (ARNG) State Headquarters, not the MTF. The website for information pertaining to the PDES is located at US Army HRC Physical Disability Agency Patient Administration Division Veterinary Services