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Confidential Mental Health Resources Available to Military Families
“Checking in on your mental health can be as easy as making an appointment with a mental health professional, such as a therapist or psychiatrist – and that can be done face to face or virtually,” said U.S. Air Force Lt. Col. Anna Fedotova, mental health flight commander, Kirtland Air Force Base, New Mexico.
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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.
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Use this form if the researcher intends to conduct research that is solely on the protected health information (PHI) of decedents, the PI may submit this template to document the required representations, as outlined above, that are necessary for compliance with the HIPAA Privacy Rule and Department of Defense (DOD) Health Information Privacy Regulation (DOD 6025.18-R).
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Use this form if the researcher has not received documentation from an Institutional Review Board (IRB) or HIPAA Privacy Board approving a waiver or alteration of Authorizations and reasons exist that make it impractical or impossible for the researcher to obtain Authorizations from each research participant, the PI may submit an Application for a Waiver of Authorization or an Altered Authorization. A DHA Privacy Board member will conduct an expedited review of the completed application and determine whether to approve or deny an altered Authorization or a full or partial waiver of Authorizations.
Use this form to request a copy of your mitochondrial DNA type to help recover family member remains.
Health Insurance Claim form for Medicare Professional Services.
This form should be completed and signed by the prescriber to request prior authorization to use a brand name drug instead of a generic equivalent.
This form is for institutional providers to apply for enrollment in the Medicare program or make a change in their enrollment information.
This form is a tool that can be used when a collaborating investigator is not part of an institution with a federal assurance.
Use this form to grant permission to the Armed Forces Medical Examiner System to retain organs for an extended examination to determine cause of death.
This form should be used when an institution will be engaged in human subject research and will use an Institutional Review Board (IRB) that is not organizationally or legally part of the institution.
Use this worksheet when referring a service member under the Supplemental Health Care Program.
Designed to help investigative agencies to better understand the circumstances and factors contributing to unexplained infant (less than 1 year old) deaths. View more information about the form at: http://www.cdc.gov/sids/SUIDRF.htm
This form is a tool to help Institutions with an existing FWA approved by DHHS to know about and acknowledge key DOD policies and requirements since the DHHS FWA does not identify DOD requirements.
This form is used to note clinical or follow-up care after receiving a smallpox vaccine.
The Office of the Under Secretary of Defense for Personnel and Readiness requires that all research investigators (principal investigators as well as associate investigators) engaged in research with one of its institutions explicitly acknowledge and accept responsibility for protecting the rights and welfare of human research subjects as stated therein.
The appearance of hyperlinks does not constitute endorsement by the Department of Defense of non-U.S. Government sites or the information, products, or services contained therein. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website.