DHA-GL Worksheet-06: Surgical Pre-Authorization Request
Defense Health Agency - Great Lakes Worksheet (DHA-GL Worksheet-06) This form is used to request pre-authroization for surgical care from the DHA, Great Lakes.
Accessing Military Health Care During Lapse in Appropriations
The Military Health System will continue to provide health care during a government lapse in appropriations. There may be some effects on the delivery of health care services within military hospitals and clinics. Contact your hospital or clinic to confirm hours of operations and services provided.
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Defense Health Agency - Great Lakes Worksheet (DHA-GL Worksheet-06) This form is used to request pre-authroization for surgical care from the DHA, Great Lakes.
Please complete the TRICARE Retail Pharmacy Refunds Manufacturer Questionnaire and email to UFVARR_Requests@mail.mil.
This template shall be used to notify the DHA Privacy and Civil Liberties Office (Privacy Office) that the Applicant / Recipient listed in an executed Data Sharing Agreement (DSA) has been replaced by a new Applicant / Recipient.
This template is for the sole purpose of certifying that data used in connection with a Data Sharing Agreement (DSA) that was executed with the DHA Privacy and Civil Liberties Office (Privacy Office) has been appropriately disposed of in a timely manner.
This template shall be used to notify the DHA Privacy and Civil Liberties Office (Privacy Office) that the Government Sponsor listed in an executed Data Sharing Agreement (DSA) has been replaced by a new Government Sponsor.
Student enrollment form to register in the DMRTI EWSC Course
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 conditions noted on the prescreening form (DD 2807-2). An additional ...
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.
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.
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.
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