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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Instructor CME Disclosure form
The RRT asks researchers whether they intend to put data into a repository, and if yes, what data and under what governance terms.
The Data Sharing Agreement Application (DSAA) is used when requesting data from systems that are owned and/or managed by DHA.
Fillable student enrollment form for EWSC registration.
Student/nominee JOP course request form.
This Section addresses the Contractor’s requirements under The Privacy Act of 1974 (Privacy Act), The Freedom of Information Act (FOIA), and The Health Insurance Privacy and Accountability Act (HIPAA) as set forth in applicable statutes, implementing regulations and DoD issuances.
A form for screening both children and adults for contraindications to receiving influenza vaccine.
The HIPAA Safeguard Review of Non-Federal Systems (HSR) is used when data obtained through a DSAA will be stored, transmitted, processed, or otherwise maintained on a non-federal information system.
Dental Common Access System (DENCAS)
A checklist to evaluate competency in administering the influenza vaccine, to include customer service, patient screening and education, and administration technique and procedures.
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.
Unsolicited Proposal Information Supporting COVID-19
DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101
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