According to Wikipedia, Tricare, which was formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), was a healthcare program of the United States Department of Defense Military Health System. Tricare provided health benefits for military personnel, military retirees, and their dependents.

Like any other organization, Tricare aims to protect the confidential information of their constituents. This is why they use certain Tricare Authorization Forms to gain consent before they release such confidential information. Aside from the ones on this article, you may also browse our other Authorization Forms for your perusal and use as basis for your own.

Tricare Authorization Request Form

Details
File Format
  • PDF

Size: 450 KB

Download

Tricare Authorization/Referral Form

Details
File Format
  • PDF

Size: 90 KB

Download

Tricare Authorization to Disclose Form

Details
File Format
  • PDF

Size: 200 KB

Download

Tricare Change Authorization Form in PDF

Details
File Format
  • PDF

Size: 90 KB

Download

Tricare Authorization For Disclosure Of Medical

Details
File Format
  • PDF

Size: 60 KB

Download

Uses of Tricare Authorization Forms

  • Release of Information: Whenever a beneficiary’s information has to be released for whatever purpose it may serve, a Tricare Authorization Form has to be filled out by the beneficiary before Tricare can release any confidential information to the designated organization. This is so that the privacy of the beneficiary may be protected. Release of information may be necessary for personal use, insurance purposes, and retirement, among other things. The information to be disclosed has to be specified in the form as well. You may also see our Medical Authorization Forms for other authorization forms.
  • Enrollment or Changes: This is filled out when enrolling or re-enrolling in a Tricare program, or when there is any information that changed and has to be updated, such as contact details, address, and name changes. A Tricare Authorization Form can also be used to terminate an enrollment in a Tricare program.
  • Electronic Funds Transfer: This is an option provided for Tricare beneficiaries as a way for them to be paid their benefits. Instead of getting a check in the mail, the funds are going to be sent directly into their checking or savings account instead, but an authorization form has to be filled out before doing so.

Tricare Nursing Authorization Request Form

Details
File Format
  • PDF

Size: 80 KB

Download

Tricare Authorization Notification Form

Details
File Format
  • PDF

Size: 120 KB

Download

Tricare Medical Authorization Form

Details
File Format
  • PDF

Size: 90 KB

Download

Tricare for Life EFT Authorization Form

Details
File Format
  • PDF

Size: 50 KB

Download

  • Patient Referral: In times when a beneficiary has to be referred to another medical facility or hospital, a Tricare Authorization Form has to be filled out so that his medical records can be released to the new or receiving facility. This is done so that the continued care of the beneficiary will be ensured, because the medical facility will have all the information they need to continue his medical treatment.

Information to Be Included

  • Beneficiary information
  • Specific information to be disclosed
  • What the purpose is for disclosing the specified information
  • The expiration date of the authorization
  • Any other necessary and stipulated agreements
  • Signature of the beneficiary or requestor, along with the current date
  • Signature of the beneficiary’s representative, if the beneficiary is unable to affix his own signature onto the form

As you can see, there are various purposes of Tricare Authorization Forms. They are filled out, not only for the protection of the privacy of the beneficiaries but also for the organization to avoid any legal liabilities in the future. These have to be kept in a safe place for use in the future if necessary. Aside from Tricare Authorization Forms, you may also see our Credit Card Authorization Forms for credit card transactions.

Related Posts