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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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.
Dental Common Access System (DENCAS)
Veterinary Services Systems Management (VSSM)
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the AHLTA system.
Please complete the TRICARE Retail Pharmacy Refunds Manufacturer Questionnaire and email to UFVARR_Requests@mail.mil.
Armed Forces Health Surveillance Branch (AFHSB) Epidemiology and Analysis Data Request Approval Process (RAP) Form
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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 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.
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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Use this form to request sensitive data in support of deployments (P-MART) or warriors in transition (WTU-MART).
Submit this form if you believe that one or more of the exceptions to the eligibility criteria for TRICARE Prime Remote enrollment are met. Only service members or unit commanders can submit this form.
JMOC - JMPT Nomination Form
DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101
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