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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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Medical Readiness Decision Support System (MRDSS)

Form/Template
10/22/2021

Medical Readiness Decision Support System (MRDSS) is an automated information system on the Global Information Grid (GIG) used by the Air Force Medical Services (AFMS) to manage readiness information in direct support of active Air Force units, Air National Guard, and Air Force Reserves, at fixed bases, and deployed locations during both peace and wartime operations.

Limited Duty Sailor Marine Readiness Tracker (LIMDU SMART)

Form/Template
10/20/2021

LIMDU SMART provides Navy and Marine Corps with a real-time visibility of all personnel on limited duty status, capability to run reports on all aspects of Limited Duty (LIMDU) program, and electronically manage process workflows.

HIV Management Service (HMS)

Form/Template
10/20/2021

HIV Management Service (HMS) is a Private web-based information management system, owned, operated and maintained by the Navy Bloodborne Infection Management Center, used to conduct infectious disease-related administrative reporting, patient tracking, and allowing Infectious Disease on-line transaction processing (OLTP) to access, validate, and conduct statistical analysis.

PSP Materials Account Registration Form

Form/Template
9/7/2021

Account registration form for PSP Education Materials Online Ordering System

Recommended Content:

Order Patient Safety Materials

Initial/Annual Competency Assessment Checklist: Influenza Vaccine Administration

Form/Template
8/19/2021

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

Recommended Content:

Influenza, Northern Hemisphere

TCCC ASM Student Registration v2

Form/Template
8/17/2021

Defense Medical Readiness Training Institute (DMRTI) TC3 ASM Course Manager Student Enrollment Form

Recommended Content:

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

Offsite Clinic Vaccine Inventory Issue Return Receipt and Temp Log Fahrenheit

Form/Template
8/4/2021

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
8/4/2021

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 FROZEN Vaccine Inventory Issue Return Receipt and Temp Log Celsius

Form/Template
8/4/2021

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

DHA Form 116: Pediatric and Adult Influenza Screening and Immunization Documentation

Form/Template
7/1/2021

A form for screening both children and adults for contraindications to receiving influenza vaccine.

Recommended Content:

Immunizations

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

AFMES Form 3: Autopsy Request

Form/Template
6/9/2021

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

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.

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DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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