Special Needs Program Management Information System
Forms & Templates
On this page, you will find various forms that Military Health System uses to support its programs. Please scroll down the page or use the search box to find specific forms and templates.
Please note that files more than five years old may not be compliant with Section 508 of the Rehabilitation Act. If you need an accessible version of a particular file, please contact us and we will provide one for you.
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Recent Forms & Templates
35th MDG Misawa AB MEDCOI
Online Base of Information Widely Accessible over Network
MHS GENESIS OC3 Electronic Health Record CORE
Navy Medicine Enterprise Web Services
Keller ACH - West Point MEDCOI
Nutrition Management Information System
Automated Neuropsychological Assessment Metrics Military Performance Database
Anatomic Pathology Laboratory Information System
375th MDG Scott AFB MEDCOI
Popular Forms & Templates
DHA-GL Worksheet 02: Pre-Authorization Request
Neurobehavioral Symptom Inventory Form
Patient Global Impression Change Scale
DHA-GL Worksheet 01: Medical Eligibility Verification
Medical Readiness Decision Support System (MRDSS)
Limited Duty Sailor and Marine Readiness Tracker MHS Application Access Gateways
Financial Management Information System
CS SCE 2875
DHA-GL Worksheet 03: Formal Appeal Request
Palmetto Government Benefits Administrator (PGBA)
We found 484 items
Fact Sheet
March 30, 2017
Rhabdomyolysis by Location, Active Component, U.S. Armed Forces, 2012-2016 Fact Sheet
.PDF |
313.80 KB
This fact sheet provides details on Rhabdomyolysis by location for active component, U.S. Armed Forces during a five-year surveillance period from 2012 through 2016. The medical treatment facilities at nine installations diagnosed at least 50 cases each and, together approximately half (49.9%) of all diagnosed cases.
Fact Sheet
March 30, 2017
Heat Illnesses by Location, Active Component, U.S. Armed Forces, 2012-2016 Fact Sheet
.PDF |
267.04 KB
This fact sheet provides details on heat illnesses by location during a five-year surveillance period from 2012 through 2016. 11,967 heat-related illnesses were diagnosed at more than 250 military installations and geographic locations worldwide. Three Army Installations accounted for close to one-third of all heat illnesses during the period.
Fact Sheet
Dec. 13, 2016
Assessment and Management of Oculomotor Dysfunctions Associated with Traumatic Brain Injury Fact Sheet
.PDF |
656.01 KB
This fact sheet is intended to assist all who provide rehabilitative care to survivors of traumatic brain injury (TBI) affected by visual dysfunctions. The information contains accepted practices for rehabilitation and treatment strategies for oculomotor dysfunctions.
Fact Sheet
Sept. 20, 2016
RFQ HT9402-16-Q-0017
.PDF |
141.83 KB
Formulary Management RFQ from the November 2016 P&T Committee Meeting
Fact Sheet
Sept. 6, 2016
Decision Tree Matrix for Contracts with PII/PHI
.PDF |
183.61 KB
Personally Identifiable Information (PII), Protected Health Information (PHI), and Federal Information Requirements
Fact Sheet
Aug. 8, 2016
Pre-Proposal Meeting Minutes
.DOCX |
26.75 KB
Meeting Minutes from August 23, 2016 Pre-Proposal Teleconference.
Fact Sheet
July 13, 2016
Visual Field Loss Fact Sheet
.PDF |
641.34 KB
This fact sheet is an overview of accepted practices for rehabilitation strategies for visual field loss and is intended to assist all who provide eye care and rehabilitation to individuals with visual field loss caused by traumatic or acquired brain injury.
Fact Sheet
June 24, 2016
DoD P&T Committee Uniform Formulary August 2016 RFQ
.PDF |
366.80 KB
Request for Quotation for the Uniform Formulary Blanket Purchase Agreement (UF BPA) and the Uniform Formulary Additional Discount Program (UF ADP) for the August 2016 P&T Committee Meeting.
Fact Sheet
March 1, 2016
Uranium
This fact sheet describes the element, Uranium, and its primary health effects.
Fact Sheet
Feb. 18, 2016
DOD P&T Committee Class Evaluation Information
.PDF |
265.03 KB
Lists the pharmaceutical agents the DOD P&T Committee intends to evaluate at the May 2016 DOD P&T Committee meeting.
Fact Sheet
Jan. 20, 2016
Quick Sheet - Influenza Program Overview
.PDF |
110.68 KB
Influenza Program Overview for Influenza Surveillance Program Sentinel Sites
Fact Sheet
Jan. 20, 2016
Quick Sheet for Public Health/Preventive Medicine
.PDF |
100.61 KB
Quick Sheet for Public Health/Preventive Medicine for Influenza Surveillance Program Sentinel Sites
Fact Sheet
Jan. 20, 2016
Quick Sheet for Laboratory Officers
.PDF |
114.10 KB
Quick Sheet for Laboratory Officers for Influenza Surveillance Program Sentinel Sites
Fact Sheet
Jan. 20, 2016
Quick Sheet for Physicians or Providers
.PDF |
102.09 KB
Quick Sheet for Physicians or Providers for Influenza Surveillance Program Sentinel Sites
Fact Sheet
Nov. 24, 2015
Vision Problems Associated with Traumatic Brain Injury Brochure
.PDF |
409.26 KB
This TBI patient brochure provides a list of common causes, signs and symptoms of TBI related vision problems.
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