United States Department of Veterans Affairs

Captain James A. Lovell Federal Health Care Center

Family Practice Forms

Commonly Used Forms

Clinic Check-in Form (TSWF form) – Facilitate checking-in for your appointment by bringing this form prefilled to your appointment. Check-in Form 

Captain James A. Lovell FHCC Registration Form 

PHARMACY - Pharmacy Pick-Up Authorization Form

 


EXCEPTIONAL FAMILY MEMBER PROGRAM 

WELL CHILD AND SCHOOL/SPORTS PHYSICAL EXAMS

State of Illinois Handicap Parking Placard Application – http://www.cyberdriveillinois.com/publications/pdf_publications/vsd62.pdf

State of Wisconsin Handicap Parking Placard Application – http://www.dot.state.wi.us/drivers/forms/mv2933.pdf

United States Department of Labor Family and Medical Leave Act Resources – Contains information and required forms. https://www.dol.gov/agencies/whd/fmla

PEDIATRIC RESOURCES

 



Lovell DoD Medical HomePort
Family Practice
Internal Medicine
Pediatrics


Family Practice Forms

Family Practice Resources

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