Exhibit H_Service Appointment RequestV2.docx

This document is an Exhibit H Service Appointment Request template detailing the specific data elements required to be collected when scheduling service appointments for military personnel. The template includes 15 comprehensive data points to capture critical information about the service member, including full name, rank, DoDID, contact information, unit details, deployment status, civilian employer information, and scheduling contact details.

The template is part of the Remote Health Readiness Program-4 (RHRP-4) contract, which is solicited by the Defense Health Agency to provide medical and dental readiness services for Reserve Components, Active Components enrolled in TRICARE Prime Remote, DoD Service Civilians, and Department of Homeland Security members. The data collection template appears designed to facilitate efficient scheduling and tracking of medical and dental service appointments for these specified personnel groups.