Exhibit H_Service Appointment Request.docx
DOCX document 26 KB Posted
- Attached to
- Remote Health Readiness Program 4 (RHRP-4) Federal contract opportunity
- Solicitation number
- HT001125R0020
- Issued by
- Defense Health Agency
About this file
This is a data collection template (Exhibit H) for scheduling service appointments under the Remote Health Readiness Program 4 (RHRP-4) contract. The template outlines 14 required data fields that must be captured when scheduling service appointments, including service member's personal information (name, rank, DoDID, contact details, home address), unit information (unit name, UIC/RUC, address, POC details), deployment status, and scheduler information. The template is designed to support the Defense Health Agency's delivery of medical and dental readiness services to Reserve Components, Active Components enrolled in TRICARE Prime Remote, DoD Service Civilians, and Department of Homeland Security members.
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Text version
RHRP-4 PWS Exhibit H_Service Appointment Request Data to Collect for Service Appointments
| 1. Service Member (SM) Full Name and Rank |
| (Last Name, First Name, Rank) |
2. SM DoDID
3. SM Address (Home of Record)
| 4. SM Phone Number |
| (xxx)xxx-xxxx |
5. SM E-mail
6. SM Preferred Contact Method
7. SM Unit Name and UIC/RUC
| 8. SM Unit POC Name and Rank |
| (Last Name, First Name, Rank) |
9. SM Unit Address
| 10. SM Unit POC Phone number |
| (xxx)xxx-xxxx |
11. SM Unit POC Email
| 12. Is SM deploying? |
| Yes or No |
| 13. Scheduler (Name and contact number of person who scheduled appointment) |
| (Last Name, First Name, Rank) |
(xxx)xxx-xxxx
14. Comment Box
File details come from the government source that posted it. Updated .