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
Security Incident Procedures
This HIPAA Information Paper describes Security Incident Procedures (updated September 2012).
Decedents: Use and Disclosure
This HIPAA Information Paper describes the Decedents: Use and Disclosure (updated February 2012).
Sending and Receiving PHI by Facsimile
This HIPAA Information Paper describes the Sending and Receiving PHI by Facsimile (updated August 2010).
Data Sharing Agreement Applicant/Recipient Role and Responsibilities
This documents outlines the roles and responsibilities of the applicant/recipient as part of a Data Sharing Agreement (DSA).
Data Sharing Agreement Government Sponsor Role and Responsibilities
This documents outlines the roles and responsibilities of the government sponsor as part of a Data Sharing Agreement (DSA).
General Mapping of HIPAA Security Rule to Existing DOD Policies and IA Controls
This document represents an updated mapping of the HIPAA Security Rule to select DOD policies and IA controls. It does not constitute the rendering of legal advice or an exhaustive list of all possible mappings of the Security Rule to DOD policies or IA controls. The document is intended to provide general information and to allow different ...
HIPAA Identifiers
This document outlines 18 Health Insurance Portability and Accountability Act (HIPAA) Identifiers of concern to privacy when dealing with other people's information.
Privacy Act HIPAA Training Course Program
This document explains that the Privacy Act and HIPAA Training Course is now eligible for 1 continuing education unit (CEU).
Prerequisites to DHA Privacy Board Review
This flowchart outlines the requirements that must be initiated before the DHA Privacy Board reviews a research project for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and Department of Defense (DoD) Health Information Privacy Regulation (DoD 6025.18-R).
DHA Privacy Board Review Process for Research Related Data Requests
This flowchart outlines the process the DHA Privacy Board uses to review research related data requests for protected health information (PHI) about individual research participants for Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule compliance.
Protected Health Information Management Tool (PHIMT)
PHIMT stores information about Protected Health Information (PHI) disclosures, authorizations and restrictions for the Defense Health Agency.
TRICARE Encounter Data (TED)
TED records, collects, verifies and tracks millions of dollars annually in purchased care claims and encounter data for TRICARE.
Information on Depleted Uranium
Provided by the War Related Illness and Injury Study Center of the Department of Veterans Affairs, this fact sheet is a resource for veterans, service members and their families.
Managers Internal Control Program Fact Sheet
Overview and processes supporting the Managers' Internal Control Program
Machine-Readable Policies Information Paper
This Information Paper provides an overview of the E-Government (E-Gov) Act of 2002 mandating the use of machine-readable privacy policies by Federal agencies on websites used by the public.
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