Eye prescriptionMedical report Consultation - Military Guide Central
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DD Form 771: Eyewear Prescription

What is DD Form 771?

The DD Form 771, is the eyewear protection form. It is used to get prescription glasses for active duty and members.

What do DD Form 771 come in?

Now it depends on the addition date, but the DD Form 771 may have a three-carbon copy form. It could also have a two-part carbonless form. And it could even have a computer-generated form using virtual copies. The original of the form, if using the specialized copies, will be sent to the optical lab and a copy of the form will be placed in the patient’s medical records.

The DD Form 771 is normally sent via computer modem or fax.

There are 3 parts to a DD Form 771

There are actually three major areas that are covered by DD Form 771. The major areas are as follows:

Patient information

This information is necessary to establish eligibility and to provide the requesting activities within the address. This also allows the patient to receive a receipt of the completed sunglasses.

Prescription information

The prescription is the technical portion of the order form. Just make sure that this prescription is transferred completely.

The main parts of the prescription are interpupillary distance, frame size, template length, plus and minus designate wars for both the sphere and the cylindrical powers, segment powers and heights, prism, and prism base.

You don’t need to calculate decentration in the single vision or multifocal portions of the order

It is also not needed to transpose any prescription into plus or minus cylinder form.

Just leave the prescription as it is and copy it into the DD Form 771. Make sure to take notes of any sections that the prescription has been copied and is left in the patient’s health records.

Miscellaneous information

This is mostly here for any information that a corpsman feels that the Navy optical laboratory may find interesting or useful.

Sometimes the laboratory may need information that includes special fabrication requirements such as a multifocal lens and proof of eligibility for specialized eyewear such as aviator glasses.

The standard issued items can be determined from NAVMEDCOMINST 6810.1 series, Ophthalmic Services.

Try to fill out the DD Form 771 by typing it in

The DD form 771 should be tight or computer-generated whenever it is possible. This helps eliminate any misreads or errors that someone’s handwriting can cause. If there is any missing information, it could very well delay the results at the fabricating facility. It can also cause the patient to receive an incorrect pair of glasses.

What to do if the DD Form 771 is illegible

If the corpsman cannot read what has been written on the eyewear prescription, they must contact the optometrist for clarification. If the optometrist cannot be contacted or is not available, send a photostatic copy of the prescription to the optical laboratory rather than transcribing information that may be unclear. Make sure the copy of the prescription is accompanied by a completed copy of the DD form 771.