MHS GENESIS Patient Registration Module & Patient Portal

OMB 0720-0064

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 2022-10-31 and can be found here.

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