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Student enrollment form to register in the DMRTI EWSC Course
Use this form to request a speaker from the Defense Health Agency. Try and submit your request as early as possible to allow our potential speakers time to coordinate their demanding schedules. 90 days of notice is a good rule of thumb, especially for events that require travel.
The primary collection of this information is from individuals seeking to join the Armed Forces. The information collected on this form is used to assist DOD physicians in making determinations as to acceptability of applicants for military service and verifies disqualifying medical condition(s) noted on the prescreening form (DD Form 2807-2).
Welcome Letter for the DMRTI C4 Course
Use this form to request a new NCPDP/NPI Number
Use this form to requests a new ePharmacy NCPDP/NPI number
Your information is collected to allow recovery from third parties for medical care provided to you in a military treatment facility.
The Vendor Information Form provides a standard way to collect your ideas, problem statements, and/or proposed solution sets for defense health IT.
For assistance completing this form or any other related information, e-mail the DHA PASS general mailbox dha.jbsa.pharmacy.mbx.pass@mail.mil or call the DHA PASS at 1-866-275-4732 / (210) 536-6650, press option 1.
Use this form to submit feedback about the webinar on June 22, 2016 titled, "An Overview of the TRICARE Retail Refunds Program Dispute Resolution Process."
This form is used to establish a DNA reference specimen repository and database of information from kindred family members of unaccounted for/unidentified service members or other individuals needing to be identified. DNA will be extracted from a biological specimen or personal effect and used in identifying human remains.
Privacy Impact Assessment (PIA) Summary for Defense and Veterans Eye Injury and Vision Registry (DVEIVR)
Privacy Impact Assessment (PIA) Summary for the Military Health System (MHS) Data Repository (MDR)
MDR Export Transmittal Form. This needs to be filled out if you are exporting more than 10,000 records.
UF BPA and UF ADP Appendix for Acne Agents-Topical Acne and Rosacea Agents
The appearance of hyperlinks does not constitute endorsement by the Department of Defense 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.
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