An official website of the United States government

Here's how you know

Official websites use .mil

A .mil website belongs to an official U.S. Department of Defense organization in the United States.

Secure .mil websites use HTTPS

A lock () or https:// means you’ve safely connected to the .mil website. Share sensitive information only on official, secure websites.

Skip to main content (Press Enter).

Ireland Army Health Clinic

Search This Site: Search

Getting Care
Health Services
Patient Resources
News & Gallery
Clinics
About Us
TRICARE

The Ireland Army Health Clinic, Pharmacies and Jordan Dental Clinic will be closed January 20, in observance of Martin Luther King Jr. Day.

HomePatient ResourcesForms

Patient Resources

Customer Service
DHA Office of the Inspector General
EDIS
FAQs
Forms
Healthcare Resolutions
How'd We Do?
MHS GENESIS
MHS Notice of Privacy Practices
Patient Affairs
Patient & Family-Centered Care
Patient Rights & Responsibilities
Policies
Related Links
Virtual Education Center

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 116: Pediatric and Adult Influenza Screening and Immunization Documentation
DHA Form 207: COVID-19 Vaccine Screening and Immunization Document
DHA Form 236: Pediatric (6 months-11 years) COVID-19 Vaccine Screening and Immunization

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

Stay Connected

Email Updates

Sign up to receive TRICARE updates and news releases via email.

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 (DHA), a component of the Military Health System.

The appearance of hyperlinks does not constitute endorsement by the DHA of non-U.S. Government sites or the information, products, or services contained therein. Although the DHA may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such hyperlinks are provided consistent with the stated purpose of this website.

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.

Need to Submit a Claim?

Send it to the correct claims address.

Need Technical Help?

Find the right contact info for the help you need.

DHA Address

7700 Arlington Boulevard
Suite 5101
Falls Church, VA 22042-5101

Privacy Policy
Privacy Program
Information Quality
Open Government
Plain Writing
Accessibility/Section 508
Fraud & Abuse
FOIA
No FEAR Act
USA.gov

Hosted by Defense Media Activity - WEB.mil