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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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TBI Caregiver Support Forms

Form/Template
6/29/2021

This is a fillable and printer-friendly version of the forms available in the "Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans."

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | Patient and Family Resources

Forensic Toxicology Analysis Request

Form/Template
6/14/2021

Use this form to obtain information/specimens needed to evaluate and document forensic toxicological testing.

AFMES Form 25: Histology Request and Specimen Storage

Form/Template
6/10/2021

Use this form to obtain information/specimens needed for histology tissue processing and/or specimen storage.

Recommended Content:

Armed Forces Medical Examiner System | Forensic Pathology Investigations (FPI) | Repository of Specimen Samples for the Identification of Remains | DNA Identification Laboratory

Request for Autopsy Report and Supplemental Information

Form/Template
6/9/2021

Use this form to obtain records/reports/photos of remains by persons legally authorized access to this information.

AFMES Form 3: Autopsy Request

Form/Template
6/9/2021

Use this form to request for an autopsy report and supplemental information

TCCC ASM CM Student Registration Form

Form/Template
4/7/2021

Students must complete this form to register for the course. All forms are emailed to the DMRTI TCCC Section for processing.

Recommended Content:

Combat Support | Defense Medical Readiness Training Institute | DMRTI Course Information | Tactical Combat Casualty Care Course (TCCC)

Freezer Temperature Log - Celsius

Form/Template
3/25/2021

Temperature log for freezers storing vaccines, with form for recording vaccine storage troubleshooting.

Recommended Content:

Vaccine Storage and Handling

Freezer Temperature Log - Fahrenheit

Form/Template
3/25/2021

Temperature log for freezers storing vaccines, with form for recording vaccine storage troubleshooting.

Recommended Content:

Vaccine Storage and Handling

Refrigerator Temperature Log - Fahrenheit

Form/Template
3/25/2021

Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.

Recommended Content:

Vaccine Storage and Handling

Steps to take for Potentially Compromised Vaccine Event

Form/Template
3/25/2021

Recommended Content:

Vaccine Storage and Handling | Potential Vaccine Compromise Reporting

DHA Form 207: COVID-19 Vaccine Screening and Immunization Document

Form/Template
3/25/2021

The purpose of this form is to determine if the COVID-19 vaccine can be administered to the patient. (v11)

Recommended Content:

Coronavirus | COVID-19 Vaccine Efforts | COVID-19 Vaccine Toolkit

Refrigerator Temperature Log - Celsius

Form/Template
3/25/2021

Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.

Recommended Content:

Vaccine Storage and Handling

Emergency Vaccine Retrieval and Storage Plan Worksheet

Form/Template
3/24/2021

Recommended Content:

Vaccine Storage and Handling | Potential Vaccine Compromise Reporting

Offsite Clinic Vaccine Inventory Issue Return Receipt and Temp Log Fahrenheit

Form/Template
3/24/2021

When transporting vaccine off-site, you must log their storage temperature every hour to ensure they are kept at the required temperature range for the duration of the event.

Recommended Content:

Vaccine Storage and Handling

Offsite Clinic Vaccine Inventory Issue Return Receipt and Temp Log Celsius

Form/Template
3/24/2021

When transporting vaccine off-site, you must log their storage temperature every hour to ensure they are kept at the required temperature range for the duration of the event.

Recommended Content:

Vaccine Storage and Handling
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DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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