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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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Novavax COVID-19 Vaccine EUA Fact Sheet for Healthcare Providers

Publication
7/13/2022

The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) to permit the emergency use of the unapproved product, Novavax COVID-19 Vaccine, for active immunization to prevent COVID-19 in individuals 18 years of age and older.

Novavax COVID-19 Vaccine EUA Fact Sheet for Recipients and Caregivers

Publication
7/13/2022

The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) to permit the emergency use of the unapproved product, Novavax COVID-19 Vaccine, for active immunization to prevent COVID-19 in individuals 18 years of age and older.

DOD Uniform Formulary Drug Utilization Report for FY22Q2 (04/01/2022 - 06/30/2022)

Report
7/13/2022

The purpose of the Uniform Formulary Drug Utilization Report (UFDUR) is to monitor and trend the average adjusted 30-Day equivalent prescription trends for the primary points of service (Military Treatment Facilities (MTF), Retail, and Mail Order) for Department of Defense (DOD) beneficiaries. This report is run quarterly. The DOD does not sanction any other use of this data.

Basic Core Formulary - Extended Core Formulary Lists

Meeting Reference
7/12/2022

This is the BCF-ECF list from the current P&T minutes in spread sheet form

Prior Authorization Medication List

Meeting Reference
7/12/2022

Prior Authorization Medication List with Links to Express-scripts.com formulary webpage

Enterprise Blood Management System (EBMS) - Transfusion

Form/Template
7/12/2022

The purpose of Enterprise Blood Management System (EBMS)-Transfusion, formerly known as Blood Management Blood Bank Transfusion Service (BMBB/TS), is managing the blood transfusion aspect of the Armed Services Blood Program (ASBP), including blood records, blood orders, and transfusion patient information in the Continental United States and Outside Continental United States.

DMIS ID Historical File Layouts

Technical Document
7/12/2022

DMIS ID Historical File Layouts are published once a month.

Recommended Content:

DMIS ID Tables

DMIS ID Monthly Change August 2022

Technical Document
7/12/2022

DHA publishes DMIS ID Tables monthly for the MHS. This site provides the latest version of the DMIS ID Table for viewing, printing, or downloading, along with a change

Recommended Content:

DMIS ID Tables

DMIS ID Monthly August 2022

Technical Document
7/12/2022

DHA publishes DMIS ID Tables monthly for the MHS. This site provides the latest version of the DMIS ID Table for viewing, printing, or downloading, along with a change report.

Recommended Content:

DMIS ID Tables

DMIS ID Data Dictionary

Technical Document
7/12/2022

DMIS ID Data Dictionary is published on a monthly basis.

Recommended Content:

DMIS ID Tables

Vaccine Bin Label Examples

Publication
7/12/2022

Sample labels for organizing vaccines into bins for proper storage.

Recommended Content:

Vaccine Storage and Handling | Continuous Quality Immunization Improvement Process (CQIIP) and Virtual Continuous Quality Immunization Improvement Process (VCQIIP)

Influenza Vaccine Product List and Age Groups

Publication
7/12/2022

A list of available influenza vaccines for the 2022-23 flu season, along with age indications and other product specifications.

Steps to take for Potentially Compromised Vaccine Event

Form/Template
7/7/2022

Recommended Content:

Vaccine Storage and Handling | Potential Vaccine Compromise Reporting

Vaccines with Diluents: How to use them

Fact Sheet
7/7/2022

Be sure to reconstitute the following vaccines correctly before administering them! Reconstitution means that the lyophilized (freezedried) vaccine powder or wafer in one vial must be reconstituted (mixed) with the diluent (liquid) in another.

Recommended Content:

Vaccine Storage and Handling

Light-Sensitive Vaccines

Publication
7/7/2022

A list of vaccines that need to be protected from light during storage and before administering.

Recommended Content:

Vaccine Storage and Handling
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Last Updated: July 19, 2022

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

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