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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Please complete the TRICARE Retail Pharmacy Refunds Manufacturer Questionnaire and email to UFVARR_Requests@mail.mil.
This is a form that users will download and either FAX or mail to file a complaint to the DHA IG office.
This Privacy Impact Assessment is from Navy Medicine Online. The Navy Medicine Online (NMO) serves a vital role in the overall process of collecting, analyzing, and brokering medical readiness data to and from critical and authoritative Department of Defense (DoD) data sources into one common operational view that can be drilled down into individual units and personnel as needed. Data is only provided to DoD entities.
Defense Health Agency - Great Lakes Worksheet (DAH-GL Worksheet-02) This worksheet is used to request pre-authorization for medical care for Reserve Component Members
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the TRICARE Online (TOL) system.
Veterinary Services Systems Management (VSSM)
Dental Common Access System (DENCAS)
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the AHLTA system.
Armed Forces Health Surveillance Branch (AFHSB) Epidemiology and Analysis Data Request Approval Process (RAP) Form
MTF Drug Request Review Form
The PDTS reports function is constantly evolving and as we continue to find new applications for the data collected by PDTS, the reports function will be modified to meet those demands.
This form is used to assist providers in the identification of patients who have received prescriptions for controlled substances over a given period of time and provide them with an automated process to analyze the data.
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This form is designed to accommodate requests for patient, drug, provider, and pharmacy profiles. If you need assistance completing this form please call the number shown above. The PASS cannot act on any report request until the form has been approved and the requestor has agreed with the method of extract and the structure of the report.
Use this form to request sensitive data in support of deployments (P-MART) or warriors in transition (WTU-MART).
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.