Back to Top Skip to main content Skip to sub-navigation

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 two 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?

If you're having trouble finding what you're looking for, consider using fewer words in your search criteria. Results are limited to content that matches all terms in the search field.

We found -

Specify Date Range (Optional):
Select Content Types (Optional):
Current Filters. Click a Filter to Remove It
Date Range:

Naval Hospital Jacksonville (NHJAX) Enclave

Form/Template
8/12/2022

Complete this form for DOD information systems or electronic collections of information that collect, maintain, use, and/or disseminate PII about members of the public, Federal employees, contractors, or foreign nationals employed at U.S. military facilities internationally.

Enterprise Patient Queuing and Notification System (ePQNS)

Form/Template
7/21/2022

The Enterprise Patient Queuing Notification System (ePQNS) automates patient check-in during visits to Military Treatment Facilities (MTFs) and clinics. ePQNS provides real-time information to leadership to manage assets as wait-times increase or the situation dictates. It also allows MTFs to determine inefficiencies, identify best practices, and optimize clinic resources to improve each patient’s overall experience and reduce wait times.

Enterprise Blood Management System (EBMS) - Transfusion

Form/Template
7/12/2022

The purpose of Enterprise Blood Management System (EBMS)-Transfusion, formerly known as Blood Management Blood Bank Transfusion Service (BMBB/TS), is managing the blood transfusion aspect of the Armed Services Blood Program (ASBP), including blood records, blood orders, and transfusion patient information in the Continental United States and Outside Continental United States.

Steps to take for Potentially Compromised Vaccine Event

Form/Template
7/7/2022

Recommended Content:

Vaccine Storage and Handling | Potential Vaccine Compromise Reporting

DHA Form 249: Pharmacy Data Warehouse Data Report Request Form

Form/Template
6/21/2022

Recommended Content:

DHA Pharmacy Operations Support Contract Data Management Team | CD-MART | D-MART | WTU P-MART

TRICARE Online (TOL) System

Form/Template
5/3/2022

TRICARE Online (TOL) is a Department of Defense (DoD) Online Patient Portal (PP) which provides eligible beneficiaries with the following: access to Military Treatment Facilities' (MTFs) appointments, new prescription (Rx) fill and refills, health record data, service separation/retirement information as well as access to secure messaging (SM), and the Nurse Advice Line (NAL).

Centralized Credentials Quality Assurance System (CCQAS)

Form/Template
4/18/2022

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Centralized Credentials Quality Assurance System (CCQAS) system.

Assistance Reporting Tool (ART)

Form/Template
3/21/2022

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Assistance Reporting Tool (ART) system.

Armed Forces Billing and Collection Utilization Solution - Amazon Web Services

Form/Template
3/10/2022

The Armed Forces Billing and Collection Utilization Solution (ABACUS) provides a standard patient accounting system for health care billing practices.

Consolidated Information Center Data Warehouse

Form/Template
3/10/2022

The Consolidated Information Center (CIC) Data Warehouse is used to facilitate the Bureau of Medicine and Surgery's analytical capabilities across Navy Medicine to improve speed of decision making.

National Optronics 7Ex Optical Fabrication Edger

Form/Template
2/28/2022

7Ex is a single purpose programmable instrument that edges high base lenses using the 7Ex's unique cutter design. Performs drilling and grooving in one process with the flexibility to process all bevel cutting types.

HIV Management Service (HMS)

Form/Template
2/28/2022

HIV Management Service (HMS) is a Private web-based information management system, owned, operated and maintained by the Navy Bloodborne Infection Management Center, used to conduct infectious disease-related administrative reporting, patient tracking, and allows Infectious Disease on-line transaction processing (OLTP) to access, validate, and conduct statistical analysis.

DHA Appointing Portal

Form/Template
2/28/2022

The DHA Appointing Portal is a locally developed web application system used to automate vaccine availability and appointment scheduling. It is an enterprise-wide system currently hosted at Madigan Army Medical Center and accessible through a Defense Health Agency (DHA) website.

Veterinary Services Systems Management (VSSM)

Form/Template
2/28/2022

The purpose of the Veterinary Services Systems Management (VSSM) system via the Remote Online Veterinary Record (ROVR) application is to record and maintain complete health care information to include treatment history and deployment status on all Government Owned Animals (GOA).

Medical Readiness Decision Support System (MRDSS)

Form/Template
2/28/2022

Medical Readiness Decision Support System (MRDSS) is an automated information system on the Global Information Grid (GIG) used by the Air Force Medical Services (AFMS) to manage readiness information in direct support of active Air Force units, Air National Guard, and Air Force Reserves, at fixed bases, and deployed locations during both peace and wartime operations

<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 24
Last Updated: July 19, 2022

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.