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DoD Fertility Assisted Reproductive Technology (ART) Referral Form New Request MTF providers may submit this form securely via the MTF Provider Portal: esrx.com/mpp Update Existing Request(Instructions
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How to fill out dod-fertility-request-art-form
How to fill out dod-fertility-request-art-form
01
Obtain the DOD fertility request ART form from the proper authority or website.
02
Fill out personal information such as name, address, contact number, and date of birth.
03
Provide details about your military status and branch.
04
Include information about your spouse/partner if applicable.
05
Fill out any medical history and relevant information about your fertility concerns.
06
Sign and date the form before submitting it to the appropriate office or physician.
Who needs dod-fertility-request-art-form?
01
Military service members who are seeking fertility assistance or procedures.
02
Spouses or partners of military service members who are also seeking fertility assistance.
03
Anyone within the Department of Defense who requires assistance with fertility treatments.
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What is dod-fertility-request-art-form?
The dod-fertility-request-art-form is a form used to request fertility assistance services for military service members.
Who is required to file dod-fertility-request-art-form?
Military service members who are seeking fertility assistance services are required to file the dod-fertility-request-art-form.
How to fill out dod-fertility-request-art-form?
To fill out the dod-fertility-request-art-form, one must provide personal information, medical history, and details regarding the fertility assistance services requested.
What is the purpose of dod-fertility-request-art-form?
The purpose of the dod-fertility-request-art-form is to request fertility assistance services for military service members who require such services.
What information must be reported on dod-fertility-request-art-form?
The dod-fertility-request-art-form requires information such as personal details, medical history, and details about the requested fertility assistance services.
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