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Frequently Asked Questions

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Form/Template
Apr 8, 2014

DHA Small Vendor Business Profile List

.PDF | 155.52 KB

Defense Health Agency (DHA) Office of Small Business Programs (OSBP) uses the System for Award Management (SAM), as well as other government-wide procurement systems, such as the Federal Procurement Data Systems (FPDS), to compile data on Small Business (SB) vendors. The information gathered assists in identifying vendors, their capabilities, and ...

Form/Template
Feb 27, 2014

Researcher Responsibilities

The Researcher Responsibilities Form ensures that all investigators conducting Department of Defense (DOD) research involving human participants understand and comply with all the relevant federal and DOD regulations, including Human Protections, records management, and the Health Insurance Portability and Accountability Act (HIPAA). The form also ...

Form/Template
Dec 1, 2013

Collections Access Request

.PDF | 20.14 KB

Form used to request access to the collections at the National Museum of Health and Medicine.

Form/Template
Oct 1, 2013

MHS NoPP Acknowledgement Form

.PDF | 27.44 KB

The MHS Notice of Privacy Practices (NoPP) describes how medical information about you may be used and disclosed and how you can get access to this information. This form serves as an acknowledgement to patients and beneficiaries that they have received the MHS NoPP. The template is sized to scale and can be reproduced locally on Avery Label #5163, ...

Form/Template
Jul 8, 2013

Neuroimaging following TBI in non deployed setting

.PDF | 485.60 KB

The guidance contained in this CR represents a review of currently published literature and expert contributions obtained by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) in collaboration with clinical subject matter experts representing the Services, Department of Veterans Affairs (VA), academic, ...

Form/Template
Aug 1, 2012

Principal Investigator Certification

.PDF | 1.73 MB

Use this form if a Research Authorization Review template and an Authorization are approved by the DHA Privacy Board, a Principal Investigator (PI) will be required to sign a Principal Investigator Certification. Among other requirements, the certification ensures that the PI will maintain, electronically and/or in hard copy, the signed Authorization ...

Form/Template
Aug 1, 2012

Required Representations for Review Preparatory to Research

.PDF | 1.63 MB

Use this form if the researcher intends to conduct a review of PHI to prepare for a research protocol or for similar purposes preparatory to research (e.g., for recruitment or screening purposes) and agrees not to remove the PHI from DHA, the PI may submit this template to document the required representations, as outlined above, that are necessary ...

Form/Template
Aug 1, 2012

Required Representations for Research on Decedents Information

.PDF | 507.64 KB

Use this form if the researcher intends to conduct research that is solely on the protected health information (PHI) of decedents, the PI may submit this template to document the required representations, as outlined above, that are necessary for compliance with the HIPAA Privacy Rule and Department of Defense (DOD) Health Information Privacy ...

Form/Template
Aug 1, 2012

Research Authorization Review

.PDF | 1.60 MB

Use this form if the researcher intends to obtain HIPAA Authorizations, also known as “Authorizations,” from research participants to comply with the HIPAA Privacy Rule, the PI must submit to the DHA Privacy Board a copy of the blank Authorization(s) to be used in the project and the completed Research Authorization Review. The DHA Privacy Board will ...

Form/Template
Aug 1, 2012

DHA Privacy Board Application for a Waiver of Authorization or an Altered Authorization

.PDF | 1.57 MB

Use this form if the researcher has not received documentation from an Institutional Review Board (IRB) or HIPAA Privacy Board approving a waiver or alteration of Authorizations and reasons exist that make it impractical or impossible for the researcher to obtain Authorizations from each research participant, the PI may submit an Application for a ...

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