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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- Please visit the DHA Forms Management page on Inside DHA. CAC authentication is required.
- If you have questions, please send an email to the DHA Forms Management Office.
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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
Oct. 27, 2015
DoD P&T Committee Class Evaluation Information
.DOCX |
34.03 KB
Lists the pharmaceutical agents the DoD P&T Committee intends to evaluate at the February 2016 DoD P&T Committee meeting.
Fact Sheet
Oct. 23, 2015
PIA for Air Force Corporate Health Information Processing Service
.PDF |
87.42 KB
This Privacy Impact Assessment (PIA) for Air Force Corporate Health Information Processing Service (AFCHIPS)
Fact Sheet
Sept. 1, 2015
Department of Defense Military Caregiver Support
.PDF |
70.66 KB
The Department of Defense (DoD) provides resources and information exclusively for military caregivers who assist wounded, ill and injured Service members with activities of daily living.
Fact Sheet
Aug. 14, 2015
The Release of PHI to Congressional Offices
.PDF |
270.82 KB
This HIPAA Information Paper describes the Release of PHI to Congressional Offices (updated August 2015).
Fact Sheet
Aug. 7, 2015
DoD P&T Committee Class Evaluation Information
Lists the pharmaceutical agents the DoD P&T Committee intends to evaluate at the November 2015 DoD P&T Committee meeting.
Fact Sheet
July 9, 2015
Medical Evacuation Coverage
.PDF |
295.82 KB
Medical transport options for TRICARE beneficiaries and DoD Personnel overseas on official business who are not TRICARE beneficiaries.
Fact Sheet
July 1, 2015
Transporting PII or PHI
.PDF |
214.90 KB
This HIPAA Information Paper describes Transporting PII or PHI (updated July 2015).
Fact Sheet
July 1, 2015
Oral Communication of PHI
.PDF |
421.80 KB
This HIPAA Information Paper describes Oral Communication of PHI (updated July 2015)
Fact Sheet
June 26, 2015
Shields Save Sight On Duty and Off
.PDF |
2.31 MB
This fact sheet is intended to remind individual's to do everything they can to shield their eyes against accidents while on and off duty with protective eye wear
Fact Sheet
June 26, 2015
Shields Save Sight Fit the Gear to the Job
.PDF |
612.87 KB
This fact sheet is intended to remind individual's to wear the appropriate safety and protective eyewear for the job or task at hand. Wearing eyewear from the Authorized Protective Eyewear List will help provide the best level of protection.
Fact Sheet
June 26, 2015
Shields Save Sight 3 Steps to Save Sight
.PDF |
1.11 MB
This factsheet outlines 3 important steps to take when there is an eye injury and how properly responding can save the person's sight.
Fact Sheet
June 16, 2015
Uses and Disclosures When an Authorization is Not Required
.PDF |
536.65 KB
This HIPAA Information Paper describes the Uses and Disclosures When an Authorization is Not Required.
Fact Sheet
June 16, 2015
Victims of Abuse, Neglect, or Domestic Violence
.PDF |
517.92 KB
This HIPAA Information Paper describes the Victims of Abuse, Neglect, or Domestic Violence (updated June 2015).
Fact Sheet
May 5, 2015
Judicial and Administrative Proceedings
.PDF |
425.48 KB
This HIPAA Information Paper describes Judicial and Administrative Proceedings (updated July 2011).
Fact Sheet
March 23, 2015
Person or Entity Authentication For Information System Access
.PDF |
657.34 KB
This HIPAA Information Paper describes Person or Entity Authentication For Information System Access (Updated March 2015).
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