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On this page, you will find various forms that Military Health System uses to support its programs. Please scroll down the page or use the search box to find specific forms and templates.
Please note that files more than five years old may not be compliant with Section 508 of the Rehabilitation Act. If you need an accessible version of a particular file, please contact us and we will provide one for you.
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Use this form to request a new NCPDP/NPI Number
Your information is collected to allow recovery from third parties for medical care provided to you in a military treatment facility.
The Vendor Information Form provides a standard way to collect your ideas, problem statements, and/or proposed solution sets for defense health IT.
For assistance completing this form or any other related information, e-mail the DHA PASS general mailbox dha.jbsa.pharmacy.mbx.pass@mail.mil or call the DHA PASS at 1-866-275-4732 / (210) 536-6650, press option 1.
Use this form to submit feedback about the webinar on June 22, 2016 titled, "An Overview of the TRICARE Retail Refunds Program Dispute Resolution Process."
This form is used to establish a DNA reference specimen repository and database of information from kindred family members of unaccounted for/unidentified service members or other individuals needing to be identified. DNA will be extracted from a biological specimen or personal effect and used in identifying human remains.
Privacy Impact Assessment (PIA) Summary for Defense and Veterans Eye Injury and Vision Registry (DVEIVR)
Privacy Impact Assessment (PIA) Summary for the Military Health System (MHS) Data Repository (MDR)
MDR Export Transmittal Form. This needs to be filled out if you are exporting more than 10,000 records.
UF BPA and UF ADP Appendix for Alcohol Deterrents-Narcotic Antagonists
UF BPA and UF ADP Appendix for Acne Agents-Topical Acne and Rosacea Agents
UF BPA and UF ADP Appendix for Migraine Agents-Triptans
Privacy Impact Assessment Summary for the Clinical Enterprise Intelligence Program (CEIP)
PIA Summary for the Data Exchange Service (DES)
Guidelines for the collection and shipment of toxicology specimens
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