2023-24 Influenza Vaccine
INFORMATION		 INCLEMENT WEATHER POLICY MHS GENESIS INFORMATION
Interactive Customer Evaluation (ICE) for
Health Service Providers (West Point)
 
  • Mologne Cadet Health Clinic health care services & Cadet Sick Call has been relocated to Brian D. Allgood Ambulatory Clinic. Cadets should check in at the Primary Care Department (First Floor).
  • Saunders Dental Clinic has been relocated to Keller's Multi-Specialty Clinic. Emergency and In-processing dental only. Sick Call begins at 7 a.m..
  • Public Health has been relocated to Keller's Orthopedic Clinic (Allgood, Second Floor).
  • Occupational Health has been relocated to Keller's Multi-Specialty Clinic. 

Patient Resources

Forms

Keller Army Community Hospital Forms

  • DHA FORM 116 - Pediatric and Adult Influenza Screening and Immunization Document
  • Active Duty Dental Claim Form (531KB .PDF)
    United Concordia's network dentists will file a claim on your behalf. If you are approved to utilize a non-network dentist, you may be required to submit your own claim form. United Concordia's network dentists will file a claim on your behalf.

    Download Form
  • Child Central Auditory Processing Questionnaire
    WAMC Form 5004 - Child Central Auditory Processing Questionnaire

    Download Form
  • Authorization for Disclosure of Medical or Dental Information

    DD form 2870 (Authorization for Disclosure of Medical or Dental Information)

Defense Health Agency Forms

TRICARE Forms

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