Consider what a Department-level form is for. DD Form 2642 — CHAMPUS Claim Patient's Request for Medical Payment — was established to CHAMPUS Claim Patient's Request for Medical Payment, and it was placed in the DD sequence because the underlying transaction occurs throughout the Defense establishment in substantially the same shape. Standardizing the record was cheaper and more reliable than letting six services each design their own.
That decision has consequences you will notice. Because not stated prescribes the form for the Department as a whole, and not stated maintains it on the Department's behalf, the same blank passes between the Army, the Navy, the Air Force, the Marine Corps, the Space Force, the Coast Guard when operating under Defense jurisdiction, the defense agencies and the combatant commands without translation. A clerk in one component reads a record created in another and finds the fields where they expect them.
The edition in force is not stated, carried by the publisher as not stated, and edition discipline is stricter on a Department form than most people expect, precisely because supersession happens everywhere at once. There is no interval during which one service still works from the previous layout while another has moved on.
The form is laid out top to bottom in a sequence that reflects how the record will be read, not merely how it was drawn. Identification comes first because everything below it is understood in relation to a named person, unit or transaction; substantive entries follow; certification closes the document because certification attests to what precedes it. Filling out of order tends to produce internal inconsistencies — an entry that made sense before the header was settled and does not afterward.
Check the edition date before you type anything, against not stated. Old blanks accumulate in shared drives for years, and the cost of one is not obvious until a reviewer cannot find a field. Because DD forms are revised centrally and replaced across the Department in a single action, there is no component still tolerating the old layout as a local practice.
Unclear entries are resolved from the printed instructions first and from not stated where the two texts diverge.
Download the form
What you can download: PDF. The form runs unknown pages and asks for approximately unknown entries. The plurality of formats is deliberate: Defense distribution has never been able to assume one operating environment across the whole force.
Two states of the same page circulate, and the reason is worth knowing. In the fillable pdf, the boxes are real fields holding real data; in the printable pdf, the boxes are drawings. Where a record will cross components — as Department records regularly do — the typed version is the safer artifact. Each scan, each forwarding, each reproduction costs handwriting a little legibility, and the office that finally files the record is rarely the office that received it first.
Xfdl appears in the set for reasons of institutional inertia rather than preference. It is the IBM Lotus Forms format, once the Department's electronic forms standard and deployed widely enough that it outlived the decision to move on. IBM Lotus Forms Viewer or an equivalent client opens it; a pdf application will not.
Nothing here is charged for. Published Defense forms are public documents and distribution carries no fee, in any format. One caution about software: fill the form in a desktop pdf application rather than a browser tab. Browser-embedded viewers implement field behaviour inconsistently, and the failure mode is silent loss of everything you entered.
Route the executed form as not stated or local guidance directs, and retain a duplicate first. Cross-component routing is ordinary for DD forms, which is precisely why a personal copy earns its keep: the receiving office may belong to an organization you have no standing to query about a missing document.
Cross-referenced documents are found by series and number, with nothing further required. That the DD sequence is unified across the Department means a cited number identifies one form and no other, which is the practical payoff of centralizing the numbering in the first place.
It helps to see the DA and DD sequences as what they are: separate registries with separate custodians. One serves a single service under a service proponent, the other serves the Department under not stated or an equivalent office, and neither was ever indexed against the other. A number that appears in both systems points to two unrelated documents, which is why reading the prefix comes before reading the digits.
A form is downstream of the policy that requires it, and revision usually starts there: a directive is reissued, a collection requirement is altered, notice language is updated by statute. The form is republished as a consequence. Since none of that reaches individual users, an archived copy quietly becomes wrong, and verifying not stated each time you download is the whole remedy.
A word on what this page is. It distributes a published Department of Defense document and describes what the document contains and how it is completed. It is not the issuing authority, does not speak for one, and offers no legal advice; nothing written here determines whether a particular submission will be accepted, because that determination belongs entirely to the office receiving it. Questions of applicability, eligibility or procedure go to not stated, to your servicing personnel office, or to the office identified in not stated.
Questions and answers
- What is DD Form 2642?
- CHAMPUS Claim Patient's Request for Medical Payment
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?