DA Form 2631. Medical Care-Third Party Liability Notification

The DA Form 2631 is used by the Department of the Army to notify third-party entities about an individual's medical care that may be covered under their insurance or liability. This form is typically used when military personnel or their dependents receive medical treatment at a civilian healthcare facility.

The form consists of sections where personal information of the patient and their sponsor are recorded, along with details of the medical treatment received. It also includes fields for information regarding the third-party insurance or liability coverage, as well as the estimated cost of the medical services.

When filling out this form, it is important to accurately provide all necessary personal and insurance information to ensure timely communication and coordination with the third-party entity. The estimated cost of medical services should be carefully calculated to provide an accurate assessment.

An example practice for this form would be when a military dependent receives emergency medical treatment at a civilian hospital. The form can be used to notify the insurance provider of the dependent's sponsor, ensuring that the medical expenses are properly covered and processed through the appropriate channels.