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Ireland Army Health Clinic

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Updated May 6, 2024

Forms

Department of Defense Forms

DD Form 2527 – Statement of Personal Injury – Possible Third-Party Liability
DD Form 2870 – Authorization for Disclosure of Medical or Dental Information

Ireland Army Health Clinic Forms

Flu Shots

Defense Health Agency Forms

DHA Form 3111 - Routine Immunization Screening Form: Adult
DHA Form 3110 – Routine Immunization Screening Form: Pediatric

TRICARE Forms

Download a TRICARE Form

Don’t forget to keep your family’s information up to date in DEERS!

Logo for Ireland Army Health Clinic Ireland Army Health Clinic
200 Brule St.
Fort Knox, KY 40121
USA

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Patient Advocate

Phone: 502-626-9736
Email: dha.knox.Ireland-AHC.mbx.patient-rep@health.mil

www.tricare.mil is an official website of the Defense Health Agency, a component of the Military Health System

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