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Forms & Templates

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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Form/Template
June 12, 2023

340b Verification Form

.PDF | 203.71 KB

340b Verification Form to be completed by the manufacturer and pharmacy for any 340b claim disputes.

Form/Template
May 31, 2023

De Identification Plan Template May 2023

.PDF | 154.64 KB

Use this updated template to provide the de-identification process to be used for your project. The plan should show how MHS sensitive data elements (or quasi-identifiers) will be de-identified as well as how the 18 HIPAA identifiers will be handled.

Form/Template
May 17, 2023

72ND MDG TINKER AFB MEDCOI 508 COMPLIANT

.PDF | 737.49 KB

Privacy Impact Assessment, 72nd Medical Group (MDG) Tinker Air Force Base (AFB) Medical Community of Interest (MEDCOI).

Form/Template
May 2, 2023

AFHSD 501 Request Form

.PDF | 311.80 KB

Armed Forces Health Surveillance Division (AFHSD) Epidemiology and Analysis AFHSD 501 Request Form

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