Deployed Medicine
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.
Looking for an official Defense Health Agency Form?
- 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
374th MDG Yokota AB MEDCOI
Defense Medical Logistics - Enterprise Solution Core
Defense Medical Logistics - Enterprise Solution Amazon Web Services
Bliss AHC - Ft Huachuca MEDCOI
Expeditionary Medical Encounter Database
Naval Health Clinic Corpus Christi MEDCOI
Army Public Health Center LAN
Philips IntelliVue Information Center iX 4.x_AA
Andrews MDG JB Andrews MEDCOI
Popular Forms & Templates
Web MEDCASE Requirements and Execution 1.x AA 2990
Neurobehavioral Symptom Inventory Form
DHA-GL Worksheet 02: Pre-Authorization Request
Patient Global Impression Change Scale
DHA-GL Worksheet 01: Medical Eligibility Verification
Limited Duty Sailor and Marine Readiness Tracker MHS Application Access Gateways
Medical Readiness Decision Support System (MRDSS)
Financial Management Information System
TBI Caregiver Support Forms
Heidelberg Eye Explorer HEYEX 2
We found 492 items
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.
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).
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