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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
June 1, 2014

Formal Appeal Request

.PDF | 263.60 KB

Defense Health Agency - Great Lakes Worksheet (DHA-GL Worksheet-03) Complete this form when submitting a formal appeal for denied medical claims or denied pre-authorization requests by the DHA, Great Lakes.

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, ...

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