AF Form 250: Health Record Charge Out Request | Download PDF – The AF Form 250, officially titled Health Record Charge Out Request, is an internal U.S. Air Force document used to formally request and track the temporary removal (or “charge out”) of physical health and medical records from a Medical Treatment Facility (MTF) or records storage location.
This form helps maintain accountability for sensitive patient records, ensuring they are properly retrieved, tracked, and returned to prevent loss or unauthorized access while supporting essential activities such as medical appointments, deployments, PCS (Permanent Change of Station) moves, or administrative reviews.
Why the AF Form 250 Matters in Air Force Healthcare?
Air Force medical records contain protected health information (PHI) governed by the Privacy Act, HIPAA (via DoDM 6025.18), and Air Force policies. Physical records—especially older paper files created before widespread adoption of electronic systems like MHS GENESIS—must be carefully managed.
The AF Form 250 serves as a charge-out card or tracking slip. When a record is removed from its filing location, the form stays in its place to show who has the record, why, and when it is due back. This system is critical for:
- Ensuring continuity of care during temporary needs.
- Supporting deployments, PCS out-processing, or specialty consultations.
- Maintaining audit trails and compliance with records management rules.
- Preventing gaps in the filing system (e.g., using AF Form 614/614A charge-out records in related processes).
Note: Modern electronic health records in MHS GENESIS reduce reliance on paper forms for many routine accesses, but the AF Form 250 remains relevant for legacy physical records, certain internal transfers between clinics, or specific administrative charge-outs at MTFs.
Who Uses AF Form 250?
- Outpatient records personnel at Air Force MTFs.
- Authorized medical staff or administrators requesting records for patient care or official purposes.
- Units or clinics transferring records internally.
Patients themselves generally do not fill out the AF Form 250. Instead, they request copies of their records using DD Form 2870 (Authorization for Disclosure of Medical or Dental Information), which is the standard form for releasing PHI to the patient or third parties.
For veterans seeking copies of service medical records:
- Pre-1994 separations → National Archives (NPRC).
- 1994–2013 → Department of Veterans Affairs.
- Post-2013 → Contact the appropriate AF STR Processing Center or use eBenefits/VA portals.
How to Obtain and Use the AF Form 250?
- Download the official form: Access the current revision directly from the Air Force e-Publishing site:
AF Form 250 PDF - Request process (typically handled internally):
- Submit the completed AF Form 250 to the MTF’s outpatient medical records section or the facility holding the record.
- Include necessary patient identifiers (name, SSN/DOD ID, date of birth) and the reason for the request (e.g., “PCS out-processing,” “deployment medical review,” “specialty consultation”).
- Records staff will retrieve the file, note the charge-out details, and place the AF Form 250 (or associated charge-out guide) in the record’s original location.
- Key fields on the form (based on standard usage):
- Patient’s full name and identifying information.
- Requester’s name, organization/unit, and contact details.
- Purpose of the charge-out.
- Date charged out and expected return date.
- Signature and date.
Always follow local MTF procedures, as slight variations may exist by installation.
Important privacy reminder: All handling of medical records must comply with DoD privacy rules. Unauthorized disclosure can result in serious consequences.
Related Forms and Processes
- DD Form 2870: Primary form for patients or authorized representatives to request copies or disclosure of medical/dental information.
- AF Form 614 / 614A: General charge-out records used in broader file management.
- SF 180: Standard Form for veterans requesting Official Military Personnel Files (OMPF), which may include health record summaries.
- MHS GENESIS Patient Portal: For eligible beneficiaries to access many electronic records directly without paper forms.
During PCS, separation, or retirement, coordinate early with your MTF medical records section. Hard-copy records (especially pre-2015) may be shipped or transferred, while electronic data follows the member via the joint electronic health record system.
Best Practices and Tips for Air Force Members
- Start early: Medical record requests or transfers can take time, especially near PCS or deployment dates.
- Verify electronic access: Check the MHS GENESIS Patient Portal first for current records before requesting physical files.
- Inventory checks: Active duty health records are typically inventoried periodically to ensure accountability.
- Return records promptly: Timely return prevents delays for other patients and maintains system integrity.
- Contact your MTF: Reach out to the medical records section at your installation for installation-specific guidance.
For official policy, refer to relevant Air Force Instructions on medical records administration, patient administration (e.g., AFMAN 41-210 series supplements), and records management (AFI 33-322).
Download AF Form 250
Official Link: https://static.e-publishing.af.mil/production/1/af_sg/form/af250/af250_rev.pdf
Always use the version hosted on the Air Force e-Publishing website to ensure you have the most current revision.
Disclaimer: This article provides general informational guidance based on publicly available sources and standard practices. It is not a substitute for official military guidance. Contact your local Air Force Medical Treatment Facility, records manager, or legal advisor for mission-specific or personal circumstances. Policies and systems (including electronic transitions) can evolve.
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