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DHA Honors Military Medical Young Investigators
The Defense Health Agency’s Clinical Investigations Program recognizes U.S. Army Capt. Stephanie Bulder of Womack Army Medical Center for her research into human papillomavirus vaccination rates in service members.
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.
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Privacy Impact Assessment (PIA) for the Theater Medical Data Store (TMDS).
This form is used to identify additional Notes on Problems, Issues or Concerns of Patient or Provider related to Vaccine Assessment or Follow-up.
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To obtain medical data for determination of medical fitness for enlistment, induction, appointment and retention for applicants and members of the Armed Forces. The information will also be used for medical boards and separation of Service members from the Armed Forces.
This form is used to record DU Bioassay/Fragment Testing and Results Information
This form is used to assess your state of health after deployment or for any deployment related concern and to assist military health care providers in identifying and providing present and future medical care.
This form is to provide the patient with a means to request a restriction on the use and disclosure of his/her protected health information.
This form is to provide the Military Treatment Facility/Dental Treatment Facility/TRICARE Health Plan with a means to request the use and/or disclosure of an individual's protected health information.
Use this form to submit your Third Party Collections Program reports.
The appearance of hyperlinks does not constitute endorsement by the Department of Defense of non-U.S. Government sites or the information, products, or services contained therein. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website.