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Effective Friday, Oct. 11, 2024 -- Due to the 1st Infantry Division's DONSA (4-day weekend), all ancillary services (lab, radiology, and pharmacy) at Farrelly Health Clinic will be consolidated at Irwin Army Community Hospital.

Patient Resources

Forms

Irwin Army Community Hospital-Riley Forms

Freedom of Information Act
FOIA Request Form
Patient Records
DD Form 2870 - Authorization for Disclosure of Medical or Dental Information

DA Form 5018-R - ADAPCP Client's Consent Statement for Release of Treatment Information
Public Health
Fort Riley Water Inspection Form

Fort Riley Water Trailer Certification Guide

Pediatric and Adult Influenza Screening and Immunization Documentation
School & Sports Physicals
Child Medical Record Immunization History & Health Assessment Form

Child & Youth Services Sports Physicals Form

Kansas State High School Activities Sports Physicals Form
Travel Documents
DTS Profile – Data Entry Form

DD 1351-3 - Statement of Actual Expenses

Confirmation of Specialty Care Form
Women's Health
OB Intake Paperwork
Third Party Collection Program/Medical Services Account/Other Health Insurance

Defense Health Agency Forms

TRICARE Forms

Download a TRICARE Form

Submit

Don't forget to keep your family's information up-to-date in DEERS.