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Enrollment
Continued Health Care Benefits Program Enrollment Form (CHCBP)
Prime Disenrollment Application Form
Prime Enrollment/PCM Change Form
Extended Care Health Option (ECHO) Application

Enrollment Related
Allotment Authorization Letter Autorización para Asignación de Cuotas de Inscripción
Electronic Funds Transfer Authorization Form (EFT) - Prime
Electronic Funds Transfer Authorization Form (EFT) - TRICARE Reserve Select
Lockout Waiver Request Form
Newborn/Adoptee Waiver Request Form
Other Health Insurance Coverage Questionnaire Cuestionario de TRICARE Sobre la Cobertura de Otro Seguro Medico (OHI)
Request for Retroactive Enrollment Form
TRICARE Reserve Select (TRS) Reconsideration Request Form
TRICARE Reserve Select (TRS) Auto Charge Request Form

HIPAA
Authorization for Release of Information Form - General
Authorization for Release of Information Form - Sensitive Diagnosis
Revocation of Authorization

Claims
Appointment of Representative
Claim Form (DD2642)
Public Facility Use Certification Form
Third Party Liability Claim Form

Last Update: July 29, 2009