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Reference Center

Here you will find products from across the Military Health System. Select from the list  in the left navigation or use the advanced search:

Are you looking for DHA Publications? All publications are available on DHA SharePoint (CAC required).

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Form/Template
Jan. 30, 2017

DSA Change of Applicant/Recipient

.PDF | 89.82 KB

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Liberties Office (Privacy Office) that the Applicant / Recipient listed in an executed Data Sharing Agreement (DSA) has been replaced by a new Applicant / Recipient.

Form/Template
Jan. 30, 2017

DSADHA Certification Data Disposition 20180611

.PDF | 322.87 KB

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.

Form/Template
Jan. 30, 2017

DSA Change of Government Sponsor

.PDF | 126.07 KB

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Liberties Office (Privacy Office) that the Government Sponsor listed in an executed Data Sharing Agreement (DSA) has been replaced by a new Government Sponsor.

Form/Template
Dec. 13, 2016

Report of Medical History

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 ...

Form/Template
Nov. 2, 2016

C4 Welcome Letter

.PDF | 156.13 KB

Welcome Letter for the DMRTI C4 Course

Form/Template
July 7, 2016

MTF ePharmacy Demographic Change Request Form

.PDF | 67.33 KB

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.

Form/Template
June 15, 2016

DVEIVR PIA

.PDF | 69.53 KB

Privacy Impact Assessment (PIA) Summary for Defense and Veterans Eye Injury and Vision Registry (DVEIVR)

Form/Template
June 15, 2016

MDR PIA

.PDF | 93.41 KB

Privacy Impact Assessment (PIA) Summary for the Military Health System (MHS) Data Repository (MDR)

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