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Patient Registration Data Fields
MHS GENESIS Patient Registration Module & Patient Portal
PASanADN
Patient Registration Data Fields
OMB: 0720-0064
OMB.report
DOD/DODOASHA
OMB 0720-0064
ICR 201908-0720-001
IC 237231
Patient Registration Data Fields
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0720-0064 can be found here:
2022-10-28 - Revision of a currently approved collection
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File Modified
2019-08-02
File Created
2019-08-02
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