DD Form 2005 is the Privacy Act statement you sign at a military treatment facility to acknowledge how the Military Health System will collect, use, and share your medical information. Most of the page is printed notice text you read; the part you actually complete is three blocks — a signature, an identifier, and a date. You sign it once during registration, and it becomes a permanent part of your health care record.
The Three Blocks You Fill In
Only three fields on the form are patient-facing:
- Block 5 is your signature, or your sponsor’s. Signing acknowledges you received the Privacy Act statement and had a chance to read it.
- Block 6 is your Social Security Number or your Department of Defense ID number. This links the acknowledgment to your health record.
- Block 7 is the date, written in YYYYMMDD format. April 15, 2026 goes in as 20260415.
Bring your military ID or Common Access Card. The administrative clerk will check the identifying information you write against what appears on the card. If the facility uses MHS GENESIS, the DoD’s electronic health record platform, you may see the same statement on a screen and acknowledge it digitally instead of on paper. The information collected and the privacy protections are identical either way.
Do You Have to Give Your Social Security Number
Providing your SSN is technically voluntary, and the form says so. The authority to ask for it comes from Executive Order 9397, as amended by Executive Order 13478, which lets federal agencies use SSNs as identifiers.
In practice, declining can slow things down. The military health system has used SSNs as the primary patient identifier for decades, and many legacy records are indexed by that number. If you’d rather not write it, the DoD ID number in Block 6 satisfies the same purpose in current systems. Ask the clerk which identifier the facility prefers for pulling your existing records.
Is the Signature Required
No. Defense Health Agency policy does not treat the patient signature as mandatory. If you decline to sign, the facility will still provide your care, and your privacy rights under the Privacy Act of 1974 (5 U.S.C. 552a) are unchanged. The signature documents that the statement was presented to you. Staff will typically note a refusal in the record and move on.
When Someone Else Signs
If the patient is a minor or cannot sign because of a medical condition, a legal guardian or the military sponsor completes and signs the form on the patient’s behalf. When a sponsor signs, the sponsor’s own identifying information goes in Block 6. Ask the clerk to walk you through it if you’re registering a family member who can’t complete the form independently.
What You’re Agreeing the Form Covers
Signing doesn’t authorize anything new. It acknowledges you were told, in writing, how the Military Health System already handles your data. The statement covers all requests for personal information made by MHS health care personnel, for both dental and medical treatment, at that facility and beyond.
The form lists the categories of recipients who may receive information from your record:
- Other federal agencies involved in your care, including the Department of Veterans Affairs, Health and Human Services, and, for Coast Guard members, the Department of Homeland Security.
- Government agencies determining your eligibility for benefits and entitlements, such as disability evaluations or retirement medical assessments.
- Third-party payers, both government and nongovernment insurers, for billing so the DoD can recover the cost of care it provided.
- Public health authorities reviewing occupational or environmental exposure data.
- Government and nongovernment research organizations conducting DoD-approved research.
Your records may also be used internally for teaching, compiling statistical data, and evaluating quality of care. Protected health information in the file is also subject to the HIPAA Privacy Rule as implemented by DoD 6025.18-R, which layers additional disclosure rules on top of the Privacy Act.
The DoD maintains a set of blanket routine uses that apply across all its records systems — congressional inquiries made on your behalf, law enforcement investigations, and responses to court orders, among others. Rather than reprint every scenario, DD Form 2005 points to the DoD’s published list.
Seeing and Correcting What’s in Your Record
The same Privacy Act that requires the form gives you the right to review your file and request corrections. Under 5 U.S.C. 552a(d), you can ask any federal agency for the records it maintains about you, review them, and obtain a copy.
Getting Copies
Submit a written or electronic request at your local military hospital or clinic. You’ll need to provide identifying information — typically date of birth, SSN or DoD ID, and a photo ID. The TRICARE patient administration office at the facility handles these requests. Any fees for patient-initiated copies must be reasonable and cost-based, limited to labor, supplies, and postage. Search and retrieval fees are not allowed for your own records.
Fixing an Error
If you find something wrong — an incorrect diagnosis code, a misspelled name, outdated contact information — you have the right to request an amendment. The Privacy Act allows corrections when a record is inaccurate, irrelevant, untimely, or incomplete.
Send a written request labeled “Privacy Act Request to Amend Records” to the facility’s patient administration office or the relevant FOIA office. Identify the specific record, describe what should change, and explain why the current entry is wrong. You’ll verify your identity, and the agency will send an acknowledgment with a tracking number once they have the request.
Where the Signed Form Goes
Once complete, DD Form 2005 becomes a permanent part of your outpatient or inpatient health care record. In MHS GENESIS facilities, the acknowledgment is stored electronically inside your digital record. At facilities still using paper, the signed form is scanned into the system and the original placed in your physical file.
It stays in the record for as long as the DoD maintains that record. Its function from that point on is simple: proof that the facility met its legal obligation to notify you about how your health information would be handled before it collected any.