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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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eRX Pharmacy Lists

Report
8/16/2023

This Excel document lists the military pharmacies that accept electronic prescriptions from civilian providers. The list is printer friendly and organized in four tabs: alphabetically by Pharmacy Name; alphabetically by State or Territory; by Region (Overseas TRICARE East, TRICARE West); by Branch of Service.

National Disaster Medical System Surge Program – Substantive Interim

Report
8/16/2023

H.R 7900, HASC Report for FY 2023, 117-397, Pg. 195-196

DHA UBO CY2023 Outpatient Rates Posttest

Presentation
8/15/2023

DHA UBO July 2023 Webinar Posttest

DHA UBO Webinar CY23 Outpatient Rates

Presentation
8/15/2023

DHA UBO July 2023 Webinar - CY23 Outpatient Rates

Page 2-44: Respiratory Syncytial Virus Vaccine

Publication
8/15/2023

Errata sheet for Immunization Toolkit Ninth Edition

Respiratory Syncytial Virus (RSV) Disease and RSV Vaccine

Fact Sheet
8/14/2023

This information paper describes respiratory syncytial virus (RSV) disease and the vaccines to prevent it.

Counting Doses in Combined Regimens of Monovalent and Bivalent Hepatitis A and Hepatitis B vaccines

Fact Sheet
8/14/2023

This information paper describes the required number of doses, using various combinations of monovalent (single antigen) hepatitis A and hepatitis B vaccines and the bivalent (combination hepatitis A and hepatitis B) vaccine, to ensure adequate immunity against both diseases.

Military Aviator Cancer Study Infographic

Technical Document
8/11/2023

508-compliant PDF for Cancer Study: Military Aviator and Aviator Support Personnel infographic.

Initial/Annual Competency Assessment Checklist: Influenza Vaccine Administration

Publication
8/11/2023

A checklist to evaluate competency in administering the influenza vaccine, to include customer service, patient screening and education, and administration technique and procedures.

Autism Care Demonstration Program Extension

Report
8/11/2023

H.R 7900 HASC Report for FY203 117-397, pg. 182

Cancer Study:  Military Aviators and Aviation Support Personnel

FAQs
8/10/2023

Frequently asked questions about the military aviators and aviation support cancer study.

Healthcare Management of Patients Associated with Interpersonal Violence and the Department of Defense Forensic Healthcare Program

DHA Publication

Establishes DHA's procedures to achieve a patient-centered, trauma-informed health care response when: a patient discloses interpersonal violence such as sexual assault, domestic violence, intimate partner violence, child abuse and neglect, or other acts of unwanted violence (excluding combat injuries).

  • Identification #: 6310.01
  • Date: 8/10/2023
  • Type: DHA-PI
  • Topics: N/A

EIDS MIP Data Science Resources

Fact Sheet
8/10/2023

Enterprise Intelligence and Data Solutions Military Health System Information Platform Data Science Resources

988 blog infographic 508

Presentation
8/9/2023

Infographic of the success statistics for the 988 Suicide and Crisis Lifeline since the relaunch.

Mobile Applications for Mental Health Patients

Report
8/9/2023

H.R 7900 HASC Report for FY 2023 117-397, Pg. 195

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Last Updated: July 11, 2023
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