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  • Complete Agency Form
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About this form

Please use this form to pay for Copy Record Charges with Evans Army Community Hospital


If you have any questions regarding this form, please contact Delores Huffman (delores.a.huffman.civ@mail.mil) at 719-526-7293, 719-526-7840, or 719-526-7276.

Accepted Payment Methods:

  • Bank account (ACH)
  • Debit or credit card

This is a secure service provided by United States Department of the Treasury. The information you will enter will remain private. Please review our privacy policy for more information.

Need Help?

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Contact: Elizabeth Burlingame
Email: Click to email
Phone: 719-526-7769

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