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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The Data Sharing Agreement Application (DSAA) is used when requesting data from systems that are owned and/or managed by DHA.
Recommended Content:
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
Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.
Temperature log for freezers storing vaccines, with form for recording vaccine storage troubleshooting.
DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101
The appearance of hyperlinks does not constitute endorsement by the Defense Health Agency 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.