Special Needs Program Management Information System
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.
Looking for an official Defense Health Agency Form?
- Please visit the DHA Forms Management page on Inside DHA. CAC authentication is required.
- If you have questions, please send an email to the DHA Forms Management Office.
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Recent Forms & Templates
35th MDG Misawa AB MEDCOI
Online Base of Information Widely Accessible over Network
MHS GENESIS OC3 Electronic Health Record CORE
Navy Medicine Enterprise Web Services
Keller ACH - West Point MEDCOI
Nutrition Management Information System
Automated Neuropsychological Assessment Metrics Military Performance Database
Anatomic Pathology Laboratory Information System
375th MDG Scott AFB MEDCOI
Popular Forms & Templates
DHA-GL Worksheet 02: Pre-Authorization Request
Neurobehavioral Symptom Inventory Form
Patient Global Impression Change Scale
DHA-GL Worksheet 01: Medical Eligibility Verification
Medical Readiness Decision Support System (MRDSS)
Limited Duty Sailor and Marine Readiness Tracker MHS Application Access Gateways
Financial Management Information System
CS SCE 2875
DHA-GL Worksheet 03: Formal Appeal Request
Palmetto Government Benefits Administrator (PGBA)
We found 484 items
Fact Sheet
May 7, 2014
Privacy Act HIPAA Training Course Program
.PDF |
451.21 KB
This document explains that the Privacy Act and HIPAA Training Course is now eligible for 1 continuing education unit (CEU).
Fact Sheet
May 7, 2014
DHA Privacy Board Review Process for Research Related Data Requests
.PDF |
97.21 KB
This flowchart outlines the process the DHA Privacy Board uses to review research related data requests for protected health information (PHI) about individual research participants for Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule compliance.
Fact Sheet
Oct. 1, 2013
TRICARE Encounter Data (TED)
.PDF |
129.28 KB
TED records, collects, verifies and tracks millions of dollars annually in purchased care claims and encounter data for TRICARE.
Fact Sheet
Oct. 1, 2013
Protected Health Information Management Tool (PHIMT)
.PDF |
95.29 KB
PHIMT stores information about Protected Health Information (PHI) disclosures, authorizations and restrictions for the Defense Health Agency.
Fact Sheet
Sept. 1, 2013
Information on Depleted Uranium
Provided by the War Related Illness and Injury Study Center of the Department of Veterans Affairs, this fact sheet is a resource for veterans, service members and their families.
Fact Sheet
July 1, 2011
Managers Internal Control Program Fact Sheet
.PDF |
363.09 KB
Overview and processes supporting the Managers' Internal Control Program
Fact Sheet
July 1, 2011
Machine-Readable Policies Information Paper
.PDF |
175.68 KB
This Information Paper provides an overview of the E-Government (E-Gov) Act of 2002 mandating the use of machine-readable privacy policies by Federal agencies on websites used by the public.
Fact Sheet
June 1, 2011
2011 Health Related Behaviors Survey - Active Duty Military Questions and Answers
.PDF |
613.13 KB
Questions and answers for active duty military for the 2011 Health Related Behaviors Survey
Fact Sheet
Feb. 1, 2010
Heath Physics Society: Depleted Uranium
.PDF |
231.16 KB
This fact sheet discusses the medical effects of DU exposure
Fact Sheet
Jan. 1, 2010
Depleted Uranium Medical
This fact sheet provides an overview of DU, exposure and medical treatment available.
Fact Sheet
Jan. 1, 2010
Urine Testing for Depleted Uranium
This fact sheet briefly outlines some basic information about DU, and specifically about the medical test most often used to determine if a person has been exposed to DU.
Fact Sheet
Dec. 31, 2009
2008 Survey of Health Related Behaviors Questions and Answers
.PDF |
165.22 KB
The 2008 Department of Defense (DoD) Survey of Health Related Behaviors Among Active Duty Military Personnel assesses substance abuse, mental well-being, deployment issues, fitness, nutrition and weight management, and compares this data to select national health status goals. Health status goals are from the Department of Health and Human Services’ ...
Fact Sheet
Dec. 31, 2009
2008 Health Related Behaviors Survey Service Program Offerings
.PDF |
384.16 KB
The purpose of this study is to assess health behaviors that have the potential to impact readiness and to assess the overall well being of the Armed Forces. The Department of Defense (DoD) uses data from the Health Related Behavior (HRB) Survey to improve education, training, treatment, and counseling to support the Services and optimize individual ...
Fact Sheet
Jan. 1, 2007
Rehabilitation of Lower Limb Amputation, Version 1 - 2007
.PDF |
811.94 KB
The Clinical Practice Guideline (CPG) for the Rehabilitation of Lower Limb Amputation was developed under the auspices of the Veterans Health Administration (VHA) and the Department of Defense (DoD) pursuant to directives from the Department of Veterans Affairs (VA).
Fact Sheet
Dec. 3, 2003
Pin Point (Update)
.PDF |
278.27 KB
This is an update of the Pin Point Fact Sheet.
Page 27 of 33, showing items 391 - 405
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