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Military Health System

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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 two 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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AFMES Form 7: AFDIL Casework Request

Form/Template
5/23/2023

Armed Forces Medical Examiner System form 7 - Armed Forces DNA Identification Laboratory Casework Request.

AFMES Form 44: DFT Client Feedback Survey

Form/Template
5/23/2023

AFMES Form 44 Division of Forensic Toxicology Client Feedback Survey.

AFMES Form 42-R: Evidence Chain of Custody

Form/Template
5/23/2023

Armed Forces Medical Examiner System Form 42-R, Evidence Chain of Custody.

72ND MDG TINKER AFB MEDCOI 508 COMPLIANT

Form/Template
5/17/2023

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

CIS MIL Enclave PIA

Form/Template
5/17/2023

Privacy Impact Assessment, Clinical Information System (CIS) -.mil Enclave.

81st MDG Keesler AFB MEDCOI

Form/Template
5/17/2023

Privacy Impact Assessment, 81st Medical Group (MDG) Keesler Air Force Base (AFB) Medical Community of Interest (MEDCOI).

66th MDG Hanscom AFB MEDCOI

Form/Template
5/17/2023

Privacy Impact Assessment 66th MDG Hanscom AFB MEDCOI.

Automated Information Discovery Environment Medical Common Operating Picture (AIDE MedCOP)

Form/Template
5/17/2023

Privacy Impact Assessment, Automated Information Discovery Environment Medical Common Operating Picture (AIDE MedCOP).

DRAEGER INFINITY DELTA SERIES

Form/Template
5/17/2023

Privacy Impact Assessment, Draeger Infinity Delta Series AI.

AFHSD 501 Request Form

Form/Template
5/2/2023

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

TRICARE Retail Refund NDC Transfer Form

Form/Template
1/25/2023

Use this form to transfer Products or NDCs between Manufacturer Labelers, for billing purposes, in the TRICARE Retail Refund Program.

DHA DSA Modification Request - Data Sharing Agreements

Form/Template
1/13/2023

This template shall be used to modify an executed Data Sharing Agreement (DSA) that incorporates an approved Data Sharing Agreement Application (DSAA).

DSA Extension Request - Data Sharing Agreements

Form/Template
1/13/2023

This template shall be used to request a 30 day extension in order to continue to use the data in accordance to the executed Data Sharing Agreement (DSA).

DHA DSAA Prerequisite Checklist - Data Sharing Agreements

Form/Template
1/13/2023

This checklist is designed to ensure you have completed the Data Sharing Agreement Application (DSAA) pre-submission reviews and have the necessary documentation to submit a DSAA. You must complete and submit this Prerequisite Checklist (PRC) to the Defense Health Agency (DHA) Privacy and Civil Liberties Office (PCLO) before you submit a DSAA or it will be declined.

DHA DSA Application - Data Sharing Agreement

Form/Template
1/5/2023

This template is used to assist the Defense Health Agency (DHA) Privacy and Civil Liberties Office (Privacy Office) with its consideration of prospective data uses involving DHA data.

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Last Updated: July 19, 2022
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