DD Form 771. Eyewear Prescription

DD Form 771 - Eyewear Prescription is used by military medical professionals to provide a prescription for eyewear (glasses) to military personnel who require corrective vision aids. It serves as a prescription for eyewear to be filled by authorized optical facilities.

The form consists of sections where the patient's personal information, prescription details, and medical provider's information are recorded. It provides a comprehensive prescription for eyewear.

Key fields in this form include patient's personal information, prescription details, and medical provider's signature. Accurate completion is crucial to ensure that the patient receives the correct prescription for eyewear.

Application Example: Military personnel requiring corrective vision aids use DD Form 771 to receive a prescription for eyewear from military medical professionals. The form includes prescription details and the medical provider's signature. Proper completion ensures accurate prescriptions for eyewear.

No direct analogues to this form exist, as it addresses the specific need to provide a prescription for eyewear to military personnel.