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This form is to provide the Military Treatment Facility/Dental Treatment Facility/TRICARE Health Plan with a means to request the use and/or disclosure of an individual's protected health information.
The purpose of the Veterinary Services Systems Management system via the Remote Online Veterinary Record application is to record and maintain complete health care information to include treatment history and deployment status on all Government Owned Animals.
Use this form to submit your Third Party Collections Program reports.
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