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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Used to collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
To collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
The Data Sharing Agreement Renewal Request template is used when requesting the renewal of an executed DSA.
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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.
Please attach MTF P&T Committee comments & meeting minutes, an explanation of the rationale for the request, copies of supporting clinical evidence, and anything else that needs to be considered by the DoD P&T Committee.
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the MHS GENESIS / Defense Healthcare Management System Modernization Electronic Health Record (DHMSM EHR)
This Air Force Medical Support Agency (AFMSA) Privacy Impact Assessment (PIA) summarizes the Dental Imaging Collaborative Environment (DICE) system.
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the TRICARE E-Commerce (TMA ECS) system.
This Military Health System (MHS) Privacy Impact Assessment (PIA) describes the Spectacle Request and Transmission System (SRTS). The SRTS is a Government developed clinic and laboratory web-based application that serves as the sole electronic system for ordering and tracking military eyewear.
This process guides references how to submit Discharge Summary notification from Inpatient or Outpatient Medical Care at a VA Facility under DVA/DoD Memorandum of Agreement (MOA) for Active Duty Service Members with SCI, TBI and/or Blind Diagnoses to Defense Health Agency Great Lakes DHA-GL.
This process guides references how to submit Request for Durable Medical Equipment for Pre- Authorization of Inpatient or Outpatient Medical Care at a VA Facility under DVA/DoD Memorandum of Agreement (MOA) for Active Duty Service Members with SCI, TBI and/or Blind Diagnoses to Defense Health Agency Great Lakes DHA-GL.
DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101
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