TRICARE PRIME TRAVEL BENEFIT INTAKE FORM - med navy 2026

1. Click ‘Get Form’ to open the TRICARE PRIME TRAVEL BENEFIT INTAKE FORM in the editor.
2. Begin by entering the Patient Information. Fill in the patient's name, status, gender, date of birth, and contact details accurately. Ensure all fields are completed to avoid delays.
3. Next, provide Sponsor Information. Indicate the sponsor's status and last four digits of their SSN. Include authorization numbers and relevant dates for travel approval.
4. Complete the Non-Medical Attendant (NMA) section if applicable. Enter NMA details including name, relationship to patient, and contact information.
5. Fill out Provider Information with your Primary Care Manager's (PCM) details and any specialist information required for your appointment.
6. Finally, review all entries for accuracy before signing and dating the form. Submit it along with any required documentation through our platform for processing.

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