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Form/Template
Jun 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
Apr 8, 2014

DHA Small Vendor Business Profile List

.PDF | 155.52 KB

Defense Health Agency (DHA) Office of Small Business Programs (OSBP) uses the System for Award Management (SAM), as well as other government-wide procurement systems, such as the Federal Procurement Data Systems (FPDS), to compile data on Small Business (SB) vendors. The information gathered assists in identifying vendors, their capabilities, and ...

Form/Template
Feb 27, 2014

Researcher Responsibilities

The Researcher Responsibilities Form ensures that all investigators conducting Department of Defense (DOD) research involving human participants understand and comply with all the relevant federal and DOD regulations, including Human Protections, records management, and the Health Insurance Portability and Accountability Act (HIPAA). The form also ...

Form/Template
Dec 1, 2013

Collections Access Request

.PDF | 20.14 KB

Form used to request access to the collections at the National Museum of Health and Medicine.

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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