DoD Forms Management Program

The Official DoD Website for DoD Forms

TO OBTAIN A COPY OF THIS FORM, PLEASE CONTACT THE DEFENSE HEALTH AGENCY (DHA).

FORM INFORMATION

Form Number:  DD 1289

Title:  Prescription Form

Edition Date:  11/01/1971  

Authority:  DoDI 6040.45

For use of this form please contact:  The Defense Health Agency (DHA)