miscellaneous information. These three areas are
discussed as follows:
1. Patient Information: The specific information
required is the patients name, rank, SSN, duty
station, mailing address, and military status.
This information is required to establish
eligibility and provide the requesting activity
with an address for the patient upon receipt of
the completed eyeglasses.
2. Prescription Information: Since the spectacle
prescription is the technical portion of the order
form, you should complete it with great care,
ensuring that the prescription is transferred in its
The essential elements of the
prescription 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 and is in the
This area is
reserved for any information you feel the Navy
Optical Laboratory may need. Information the
laboratory may need includes special
fabrication requirements, such as multifocal
lenses, or proof of eligibility for specialized
eyewear, such as aviator sunglasses. Standard
issue items can be determined from
NAVMEDCOMINST 6810.1, Ophthalmic
DD Forms 771 should be typewritten or computer
printed whenever possible. This practice eliminates
Figure 12-8.Eyewear Prescription, DD Form 771: A. Computer-printed edition; B. Computer-generated edition.