OMB control number
MHS GENESIS Patient Registration Module & Patient Portal
OMB 0720-0064 · DOD/DODOASHA.
OMB 0720-0064
The information collection requirement is necessary to provide and document medical care; determine eligibility for benefits and entitlements; adjudicate claims; determine whether a third party is responsible for the cost of MHS provided healthcare and recover that cost; and evaluate fitness for duty and medical concerns which may have resulted from an occupational or environmental hazard. Obtaining this information is essential for DoD providing medical care and recovering costs.
The latest form for MHS GENESIS Patient Registration Module & Patient Portal expires 2029-01-31 and is listed under ICR 202511-0720-003.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 0720-0064_SS-A_11.26.2025.docx | Supporting Statement A |
| 0720-0064_SS-A_11.26.2025.docx | Supporting Statement A |
 MHS GENESIS Electronic Health Record PIA_ 10.8.2024.pdf | Supplementary Document |
| MHS GENESIS Electronic Health Record PIA_ 10.8.2024.pdf | Supplementary Document |
| MHS GENESIS EHR (eID3202+Sub eIDS)_SSNJ_Memo_CPO_Approved.pdf | Supplementary Document |
| MHS GENESIS EHR (eID3202+Sub eIDS)_SSNJ_Memo_CPO_Approved.pdf | Supplementary Document |
 Patient Registration Data Fields |
Other-Screenshots |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202511-0720-003 | Revision of a currently approved collection | 2025-11-26 | ||
| 202208-0720-002 | Revision of a currently approved collection | 2022-10-28 | Approved without change | |
| 201908-0720-001 | New collection (Request for a new OMB Control Number) | 2019-08-26 | Approved without change |