Form Information

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FORM NUMBER:

DD2502

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TITLE:

UNIFORM BILLING FOR INPATIENT HOSPITAL COSTS

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EDITION DATE:

19870801

CANCELLATION DATE:

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AVAILABLE FILE FORMATS:

PLEASE

Fillable Adobe:

If no hyperlink appears next to a format, the form is not available

Perform Pro:

electronically. To obtain hard copies of current forms not available in

Form Flow 2.0:

electronic format, please contact your own Military Service or DoD

Form Flow 99:

Component Forms Management Officer. Cancelled forms are not

Other:

available in electronic formats. Click on link for a list of Forms

Forms Management POCs

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REMARKS:

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ISSUANCES:

DODI 6015.23

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SPONSOR / POC:

HA

SUB-SPONSOR:

NUMBER OF PAGES:

3

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USERS*:

A N AF

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PRESCRIBED OR ADOPTED?:

P

DISPOSITION:

FUNCTION CODE:

6010

FORM CONTROLLED:

N

MANDATORY PRINT SPECIFICATIONS:

Y

RCS:

IRCN:

OMB:

0938-0279

PRIVACY ACT

N

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* All revisions and/or cancellations must be coordinated through these USERS.

DISPOSITION: S = Do NOT use previous edition. U = Use previous edition until supply is depleted.