• Agencies

21st Medical Group (0252)

Description: Conveniently use this form to pay your bill received from 21st Medical Group/Peterson AFB (0252) or associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: DHA 21ST MDG Peterson AFB 0252

39th Medical Group Incirlik Air Base Pay Patient Payment Form

Description: Please use this form to pay your Pay Patient medical bills incurred at the 39th Medical Group.
Form Number: 39MedicalPayPatient

52nd Medical Group Medical Bills

Form Number: 52nd Medical Group

633rd Medical Group (0120)

Description: Conveniently use this form to pay your bill received from 633rd Medical Group for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: 633rd MDG Langley AFB (0120)

673rd Medical Group/JBER (0006)

Description: Conveniently use this form to pay your bill received from 673rd Medical Group/Joint Base Elmendorf - Richardson (0006) or associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: DHA 673rd MDG JBER 0006

8th Medical Group Kunsan AB

Description: Conveniently use this form to pay your bill received from 8th Medical Group for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: 8th Medical Group Kunsan AB

96TH Medical Group (0042)

Description: Conveniently use this form to pay your bill received from 96th Medical Group, Eglin AFB for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: 96TH MDG EGLIN AFB (0042)

96TH Medical Group (0042) Medical Records

Description: Please use this form to pay for your Copy Record Charges from this facility. You may pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: 96th Medical Group Eglin AFB MR

A.T. Augusta Ft Belvoir (0123)

Description: Conveniently use this form to pay your bill received from A.T. Augusta Military Medical Center, Fort Belvoir or associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: A.T. Augusta MMC 0123

Bassett Army Community Hospital (0005)

Description: Conveniently use this form to pay your bill received from Bassett Army Community Hospital and associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: DHA Bassett ACH (0005)

Bayne-Jones Army Community Hospital (0064)

Description: Please use this link to pay medical bills.
Form Number: DHA Bayne Jones ACH 0064

Beaufort Naval Hospital (0104)

Description: Please use this link to pay medical bills.
Form Number: DHA BEAUFORT NH (0104)

BG Crawford F. Sams U.S. Army Health Clinic (0610)

Description: Conveniently use this form to pay your bill received from BG Crawford F. Sams U.S. Army Health Clinic or associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: DHA BG Crawford F. Sams USAHC (0610)

Blanchfield Army Community Hospital (0060)

Description: Conveniently use this form to pay your bill received from Blanchfield Army Community Hospital or associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: DHA BLACH (0060)

Brian D. Allgood Army Community Hospital (0612)

Description: Conveniently use this form to pay your bill received from Brian D. Allgood Army Community Hospital or associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number: DHA BDAACH (0612)

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