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Registration Form

Please take a moment to complete this short application. Its function is strictly to assist us in providing information that best meets your interests as they pertain to health care information privacy and security.

1. How are you affiliated with the Department of Defense?

                  

      Other:


2. If you are located at a Military Treatment Facility (MTF), please indicate your location. If you do not know the official MTF location, please see the MTF Locator as follows: http://www.tricare.mil/mtf/

      Location:


3. What is your role? Select all that apply:

        Administrative Support Services
        Ancillary Clinical -- All clinical ancillary personnel to include technicians
        Business Finance Office- Resource Management, Personnel Staff and
               Medical Operations
        Facility Support Services -- All non clinical support personnel
        HIPAA Privacy Officer
        HIPAA Security Officer
        Information Management -IM/IT
        Medical Records/Patient Administration - Patient Admin., Medical Records,
               Codes and Transcriptions
        Nursing - All clinical support personnel from Practitioner, Mid-Wife,
               Anesthetists, Staff Nurses, and LPN
        Privacy Act/FOIA Officer
        Provider - Physicians, Phy. Asst., Dentist, and researchers
        Senior Executive Staff - Executive leadership, Legal, Public Affairs and
               Marketing staff
        Tricare Beneficiaries
        Other

4. E-mail Address:







“On October 1, 2013, the Department of Defense established the Defense Health Agency (DHA) to manage the activities of the Military Health System. These activities include those previously managed by TRICARE Management Activity (TMA), which was disestablished on the same date. During the next several months, all TMA websites will change to reflect the new DHA. We appreciate your patience during this transition."
DoD Seal
7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042-5101
The appearance of hyperlinks to external Web sites does not constitute endorsement by the TRICARE Management Activity of these Web sites or the information, products or services contained therein. For other than authorized government activities, TRICARE Management Activity does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD Web site. Accessibility/Section 508