UCCI – Statement of Work (SOW) Dental Coverage for all Active Duty Service Members (ADSMs)
FOIA Library
Learn more about the Freedom of Information Act (FOIA) Reading Room, which is part of the 1996 amendments to FOIA, mandating publicly accessible "electronic reading rooms" with agency FOIA response materials and other information routinely available to the public.
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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
Oct. 4, 2017
SCE AARF
.PDF |
345.83 KB
SAS COMPUTING ENVIRONMENT (SCE) Account Authorization Request Form (AARF)
Form/Template
Oct. 4, 2017
CS SCE Access Instructions
.DOCX |
33.71 KB
Instructions for completing the necessary forms to apply for a MDR user's account
Form/Template
June 5, 2017
Enterprise Web AMEDD Electronic Forms Support System (WEB-AEFSS) (EWA)
.PDF |
181.26 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Enterprise Web AMEDD Electronic Forms Support System (WEB-AEFSS) (EWA).
Form/Template
April 10, 2017
DHA-GL Worksheet-01: Medical Eligibility Verification
.PDF |
133.79 KB
Defense Health Agency, Great Lakes Worksheet (DHA-GL Worksheet-01) This worksheet is used to confirm eligibility of Reserve Component Members
Form/Template
April 10, 2017
DHA-GL Worksheet-06: Surgical Pre-Authorization Request
.PDF |
137.36 KB
Defense Health Agency - Great Lakes Worksheet (DHA-GL Worksheet-06) This form is used to request pre-authroization for surgical care from the DHA, Great Lakes.
Form/Template
April 6, 2017
TRICARE Retail Pharmacy Program Questionnaire
.PDF |
206.22 KB
Please complete the TRICARE Retail Pharmacy Refunds Manufacturer Questionnaire and email to UFVARR_Requests@mail.mil.
Form/Template
Jan. 30, 2017
DSADHA Certification Data Disposition 20180611
.PDF |
322.87 KB
This template is for the sole purpose of certifying that data used in connection with a Data Sharing Agreement (DSA) that was executed with the DHA Privacy and Civil Liberties Office (Privacy Office) has been appropriately disposed of in a timely manner.
Form/Template
Jan. 30, 2017
DSA Change of Applicant/Recipient
.PDF |
89.82 KB
This template shall be used to notify the DHA Privacy and Civil Liberties Office (Privacy Office) that the Applicant / Recipient listed in an executed Data Sharing Agreement (DSA) has been replaced by a new Applicant / Recipient.
Form/Template
Jan. 30, 2017
DSA Change of Government Sponsor
.PDF |
126.07 KB
This template shall be used to notify the DHA Privacy and Civil Liberties Office (Privacy Office) that the Government Sponsor listed in an executed Data Sharing Agreement (DSA) has been replaced by a new Government Sponsor.
Form/Template
Dec. 29, 2016
DMRTI EWSC Registration Form
.DOC |
43.50 KB
Student enrollment form to register in the DMRTI EWSC Course
Form/Template
Dec. 13, 2016
Report of Medical History
The primary collection of this information is from individuals seeking to join the armed forces. The information collected on this form is used to assist DoD physicians in making determinations as to acceptability of applicants for military service and verifies disqualifying medical conditions noted on the prescreening form (DD 2807-2). An additional ...
Form/Template
Nov. 2, 2016
C4 Welcome Letter
.PDF |
156.13 KB
Welcome Letter for the DMRTI C4 Course
Form/Template
Sept. 9, 2016
MTF NCPDP NPI Request Form
.PDF |
67.35 KB
Use this form to request a new NCPDP/NPI Number
Form/Template
Sept. 9, 2016
MTF ePharmacy NCPDP NPI Request Form
.PDF |
94.41 KB
Use this form to requests a new ePharmacy NCPDP/NPI number
Form/Template
Sept. 1, 2016
DD Form 2569
Your information is collected to allow recovery from third parties for medical care provided to you in a military treatment facility.
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