Remote Access Request by Providers
These instructions provide the necessary steps for external Department of Defense (DoD) Providers to request access to the Tripler Army
Medical Center (TAMC) network and clinical applications hosted by TAMC. All forms, instructions, and samples are included within the
‘STEP’ to assist the requestor.
| STEP 1 | Complete DD Form 2875 - System Authorization Access Request (SAAR) |
| This form is required and must be signed by the Provider’s Supervisor confirming the justification for the request and by the Security Officer verifying a Security Background Investigation has been completed. In addition, the justification provided must substantiate the required request. |
| DD Form 2875 System Authorization Access Request (SAAR) |
| DD Form 2875 SAAR – Instructions |
| DD Form 2875 SAAR – SAMPLE |
| NOTE: Digital signatures are required on the DD Form 2875 for non-repudiation by the External DoD Provider, the Supervisor, and the Security Officer. |
| STEP 2 | Complete TAMC Form 30 – Clinical Information Systems Account Creation |
| This form is required and must be completed to request clinical application access. |
| TAMC Form 30 – CHCS / AHLTA Account Creation Request Form |
| TAMC Form 30 – Instructions |
| STEP 3 | Complete TAMC Form 835 – Acceptable Use Policy (AUP) |
| This form must be completed legibly, signed and dated. |
| TAMC Form 835 – Acceptable Use Policy (Abbreviated 2-Page Form) |
| STEP 4 | Package Submission |
| Attach the DD Form 2875 SAAR, TAMC Form 30, and the signed AUP to a digitally signed email addressed to usarmy.tripler.medcom-tamc.list.ia@mail.mil with ‘REMOTE ACCESS REQUEST in the subject line of the email. |
| Include a brief explanation to why access is being requested in the body of the email. This justification will include what duties warrant this access and how not having the request granted will impact their ability to fulfill their unit’s mission. |
| STEP 5 | Approved Packages |
| Approved External DoD Provider requests will be contacted by TAMC Systems Engineering Branch with instructions for loading the Juniper VPN client to their network device. |