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DHA Form 454: DOD Centers of Excellence Intake Form

Are you a provider?

You'll be able set up a Transplant Surgery Board to discuss a case. You'll also be able to establish regular Transplant Surgery Boards between your institution and the DOD providers in our community.

Are you a patient?

We’ll be a clearinghouse to “match” your request and needs with your closest DOD medical facility that offers the capabilities you need.

Tell Us About Your Request

* Denotes Required Text

I would like to*

How Can We Reach You?