Exhibit H_Service Appointment RequestV2.docx

DOCX document 28 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

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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.

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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(s)
(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. SM Civilian Employer Name and Address
(Business Name, Address and Zip Code)
14. Scheduler (Name and contact number of person who scheduled appointment)
(Last Name, First Name, Rank)

(xxx)xxx-xxxx

15. Comment Box

File details come from the government source that posted it. Updated .