UCCI – Statement of Work (SOW) Dental Coverage for all Active Duty Service Members (ADSMs)
FOIA Library
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Recent FOIA Documents
Delta Dental – TRICARE Retiree Dental Program (TRDP) coverage Statement of Work (SOW)
Identification and Validation of Other Health Insurance
Direct Care encounters for Multiple Sclerosis
TRICARE beneficiaries with a diagnosis of Parkinson's Disease
Number of office visits for PCOS as well as the number of diagnoses for fatigue in a 1 year timeframe
Direct Care encounters for Chronic Bronchitis, Emphysema, Bronchiectasis, and Chronic Airway Obstruction
2009 Autism Spectrum Disorder - FOIA Terms and Conditions 2
Government Required MTF Prime Service Areas
Service Assist Team After Action Report - DD Form 1423-1 Contract Data Requierments List
Popular FOIA Documents
We found 621 items
Form/Template
March 1, 2020
Routine Immunization Form Pediatric
To determine whether your child can safely receive a routine immunization.
Form/Template
Nov. 20, 2019
DHA-GL Worksheet 41: DOD/VA MOA Inpatient-Outpatient Continued Stay Review
.PDF |
448.99 KB
Used to collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
Form/Template
Nov. 20, 2019
EACE Data Request Form
.PDF |
184.74 KB
Form for users to fill out to request information/data from EACE
Form/Template
Nov. 14, 2019
DHA-GL Worksheet : Discharge Summary
.PDF |
365.17 KB
Used to collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
Form/Template
Nov. 14, 2019
DHA-GL Worksheet 07: DVA/DOD MOA Initial Referral & Authorization VAMC Richmond Only
.PDF |
2.08 MB
To collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
Form/Template
Oct. 4, 2019
Request for DOD P&T Committee Consideration of Potential Changes to the Uniform Formulary, Basic Core Formulary or Extended Core Formulary
.PDF |
43.32 KB
Please attach MTF P&T Committee comments & meeting minutes, an explanation of the rationale for the request, copies of supporting clinical evidence, and anything else that needs to be considered by the DOD P&T Committee.
Form/Template
Aug. 29, 2019
DHA-GL Worksheet 07a: DOD/VA MOA Continued Stay for SCI-TBI-Blind Rehab
.PDF |
1.92 MB
To collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
Form/Template
Aug. 29, 2019
DHA-GL Worksheet 08: DOD/VA MOA SCI-TBI-Blind DME Request Worksheet
.PDF |
1.36 MB
To collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
Form/Template
Aug. 29, 2019
DHA-GL Worksheet 07: DVA/DOD MOA Initial Referral & Authorization for SCI-TBI-Blind Rehab
.PDF |
1.95 MB
Used to collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
Form/Template
Aug. 29, 2019
DHA-GL Worksheet 07: DVA/DOD MOA Initial Referral & Authorization for SCI-TBI-Blind Rehab STAR Program
.PDF |
1.17 MB
Used to collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.
Form/Template
Aug. 29, 2019
DHA-GL: How to Submit Discharge Summary notification
.PDF |
481.03 KB
This process guides references how to submit Discharge Summary notification from Inpatient or Outpatient Medical Care at a VA Facility under DOD/VA Memorandum of Agreement (MOA) for Active Duty Service Members with SCI, TBI and/or Blind Diagnoses to Defense Health Agency Great Lakes DHA-GL.
Form/Template
Aug. 29, 2019
DHA-GL: How to Submit Request for Durable Medical Equipment Pre-Authorization
.PDF |
482.91 KB
This process guides references how to submit Request for Durable Medical Equipment for Pre- Authorization of Inpatient or Outpatient Medical Care at a VA Facility under DOD/VA Memorandum of Agreement (MOA) for Active Duty Service Members with SCI, TBI and/or Blind Diagnoses to Defense Health Agency Great Lakes DHA-GL.
Form/Template
July 22, 2019
Air Force Medical Omnibus Web Applications (AFMOWAP)
.PDF |
643.77 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Air Force Medical Omnibus Web Applications (AFMOWAP)
Form/Template
April 22, 2019
Armed Forces Billing And Collection Utilization Solution - Amazon Web Services (ABACUS-AWS)
.PDF |
633.85 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Armed Forces Billing and Collection Utilization Solution (ABACUS) system.
Form/Template
April 22, 2019
Electronic Institutional Review Board (EIRB)
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Electronic Institutional Review Board (EIRB) system.
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