(DD) Form 771, fig. 4-4). Since all of the necessary calculations for an effective prescription have already been done, the task then becomes one of effectively recording that information in the proper place and manner.
There are three major areas of consideration in completing a DD Form 771. They are patient information, prescription information, and miscellaneous information, all of which are critical areas and will be discussed in length.
1. The first area of consideration is that of patient information. The specific information required is the patients name, rate, social security number, duty station, mailing address, and military status. This information is required in order to establish eligibility and provide the requesting activity with an address for the patient upon receipt of the completed spectacles.
2. The spectacle prescription itself is the technical portion of the order form and as such should be completed with great care, ensuring that the prescription is transferred in its entirety. The essential elements are interpupillary distance, frame size, temple length, plus and minus designators for both sphere and cylinder powers, segment powers and heights, prism, and prism base. It is not necessary to calculate decentration in the single vision or multifocal portions of the order. It is also unnecessary to try to transpose any prescription into plus or minus cylinder form. Leave the prescription as is, copy it onto the DD Form 771, and note in the remarks section that the prescription has been copied as is from the record.
3. The final area to consider is that of miscellaneous information. This area is reserved for any information you may feel will be helpful in either fabrication or determining eligibility for your patient. Items that are normally entered in the space labeled special lenses or frames are types of multifocal lenses requested, any type of nonstandard lens or frame, verification of flight status for aviation spectacles, and justification for any request for unusual prescription items. Standard issue items can be determined from BUMEDINST 6810.4G.
All DD Form 771s should be typewritten whenever possible. This practice eliminates any errors by misreading an individuals handwriting. Remember, if you are not underway, help is only as far away as your phone.
To ensure that the spectacle prescription that the physician has carefully determined to be necessary to satisfy the patients visual need is provided, it is critical that you, as the corpsman, take the time to correctly order the spectacles. Any omission of information or erroneous information will result in delays at the fabricating facility or a patient receiving an incorrect pair of spectacles or both. If individuals requiring spectacles are either without or wearing inappropriate spectacles, they are not going to be as effective as possible. This could have a detrimental effect on the readiness of that individuals command.
As a last effort to interpret a prescription that a physician has written, always make a photostatic copy of the prescription and send it to the fabricating facility, rather than try to copy over some information you are unsure of. Make sure that the copy of the prescription is accompanied by a completed DD Form 771.
1. NAVMED P-117, Manual of the Medical Department, Chapter 21
2. BUMEDINST 6810.4G, Ophthalmic Services