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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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.
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Unsolicited Proposal Information Supporting COVID-19
Temperature log for freezers storing vaccines, with form for recording vaccine storage troubleshooting.
Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.
A screening checklist for contraindications to vaccines for adults.
A screening checklist for contraindications to vaccines for children and teens.
Each potential recipient of smallpox vaccine must complete this official screening form and it must be signed by a licensed health care provider prior to vaccination.
Fill out this request to place and order with the Armed Forces Repository of Specimen Sample for the Identification of Human Remains
340b Verification Form to be completed by the manufacturer and pharmacy for any 340b claim disputes.
A form for screening both children and adults for contraindications to receiving influenza vaccine.
DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101
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