Downloads

Able Company

Newsletters

ABLE COMPANY NEWSLETTER - 29 Jun 2018

Able Company's News and Events for June 2018.

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Behavioral Health Resiliency Campus

Forms

EACH FORM 62 - 1 Jun 2015

REQUEST FOR BEHAVIORAL HEALTH EVALUATION

Fill out and provide this form to request a behavioral health evaluation.

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Billing

Forms

DD FORM 2569 - 1 Sep 2016

THIRD PARTY COLLECTION PROGRAM, MEDICAL SERVICES ACCOUNT, OTHER HEALTH INSURANCE

You can help make this a reality by completing a Form DD2569 and returning it to us by email or in person at your next visit. Our hospital receives 100% of the funds reimbursed by your civilian health insurance companies to fund additional services, upgrade the facilities and equipment and add programs for our patients. You are not liable for any costs not paid by your civilian insurance to include deductibles cost-shares and co-pays.

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Memoranda

FMR (FAMILY MEMBER RATE) MEMORANDUM - 16 Nov 2017

DIRECT CARE INPATIENT BILLING RATES FOR FY 2018

Department of Defense Uniform Business Office (UBO) Fiscal Year (FY) 2018 Direct Care Inpatient Billing Rates.

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Birthing Center

Forms

OB INTAKE - 1 Nov 2017

The OB Intake form is required prior to your first appointment during pregnancy.

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Fact Sheets

FAMILY CENTERED CARE - 15 Sep 2014

Learn about the Family Centered Care approach.

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NUTRITION FACTS - 15 Sep 2014

The Harvard School of Public Health nutrition guidlines during pregnancy.

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FETAL KICK COUNTS - 12 May 2011

Counting your baby’s movements is an excellent way of knowing that your baby is doing well. Get Fetal Kick Count information and a chart for recording your baby's movements.

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OB ULTRASOUNDS - 12 May 2011

Learn about OB Ultrasounds.

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PREFERRED PREGNANCY MEDICATIONS - 5 May 2011

Over the counter medicaion reccomendations while pregnant.

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Family Readiness Group (FRG)

Manuals

Deployment Guide - 16 Mar 2018

A guide to Deployment Readiness

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Flyers

July Welcome Dinner - 25 Jul 2018

Join us on July 25, 2018 at 5:30p.m. at the Evans DFAC for our quarterly FRG Welcome event!

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MEDDAC FRG Fiscal Year 2018 Calendar of Events - 1 Oct 2017

The MEDDAC FRG events calendar for fiscal year 18.

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Hospital Commander

Memoranda

Hospital Commander's Welcome Letter - 30 Jun 2016

Welcome to the MEDDAC

Welcome to the Best Soldier and Family Centered healthcare team in the Army Medical Department, proudly serving over 70,000 Soldiers, Families and retirees.

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Presentations

Strong Families - 28 Jun 2018

Command Information Exchange (CIE)

Learn about our Strong Families resources along with information on Annual School-Sports Physicals and #MountainPostLiving.

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Rabies Information - 29 May 2018

Command Information Exchange (CIE)

Prepare for summer with information on Rabies risk, prevention, and response if bitten.

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Deployment Services - 24 Apr 2018

Command Information Exchange (CIE)

Learn about our Deployment Services along with information from our Family Advocacy Program, Child and Family Behavioral Health Services, 2018 Fort Carson Baby Expo, and the DoD Warrior Games.

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PCS Preparation - 16 Mar 2018

Command Information Exchange (CIE)

Learn how to prepare for PCS Season with tips from Medical Records, TRICARE, School Physicals, and Exceptional Family Member Program.

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Optometry and Ophthalmology

Forms

WARFIGHTER REFRACTIVE EYE SURGERY PROGRAM COMMANDER’S AUTHORIZATION - 18 Dec 2017

This authorization must be turned in prior the the scheduling of the soldier's preoperative appointment.

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PRK & LASIK Application Form - 18 Dec 2017

Warfighter Refractive Eye Surgery Program (WRESP)

Fill out and provide this form to apply for laser surgery.

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Pathology and Laboratory Services

Manuals

LABORATORY SERVICES AND SPECIMEN COLLECTION MANUAL - 8 Jun 2018

Information contained within this manual is provided as a reference for the use of available laboratory services at Evans Army Community Hospital.

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Pediatrics

Forms

DD FORM 2792 (ADDENDUM 3) - 1 Aug 2014

FAMILY MEMBER MEDICAL SUMMARY

Exceptional Family Member (EFMP) Application

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Public Affairs

Forms

DD FORM 2536 - 1 Aug 2007

REQUEST FOR ARMED FORCES PARTICIPATION IN PUBLIC EVENTS

To request a tour of Evans Army Community Hospital, please fill out this form and return to the Public Affairs Office no later than 90 days from the proposed event date. All tours and groups must complete this form and receive command approval before planning to visit Evans Army Community Hospital.

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Radiology

Forms

DD FORM 2870 - 1 Dec 2003

AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR DENTAL INFORMATION

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.

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Release of Information

Forms

DD FORM 2870 - 1 Dec 2003

AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR DENTAL INFORMATION

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.

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Memoranda

CONSENT FOR RELEASE OF DIGITAL MEDICAL RECORDS - 1 Aug 2015

RELEASE OF INFORMATIN TO PERSONAL E-MAIL ADDRESS

A completed and returned Consent for Release of Digital Medical Records Memorandum is required before digital medical records can be released.

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Women's Health

Forms

OB INTAKE - 1 Nov 2017

The OB Intake form is required prior to your first appointment during pregnancy.

Download

Fact Sheets

FAMILY CENTERED CARE - 15 Sep 2014

Learn about the Family Centered Care approach.

Download

NUTRITION FACTS - 15 Sep 2014

The Harvard School of Public Health nutrition guidlines during pregnancy.

Download

FETAL KICK COUNTS - 12 May 2011

Counting your baby’s movements is an excellent way of knowing that your baby is doing well. Get Fetal Kick Count information and a chart for recording your baby's movements.

Download

OB ULTRASOUNDS - 12 May 2011

Learn about OB Ultrasounds.

Download

PREFERRED PREGNANCY MEDICATIONS - 5 May 2011

Over the counter medicaion reccomendations while pregnant.

Download