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Military Health System

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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.

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DD Form 3042, "Annual Periodic Health Assessment"

Form/Template
8/1/2021

This form is used to periodically assess the health and well-being of active duty and reserve military servicemembers regarding force health readiness and servicemembers' suitability for deployment.

TBI Caregiver Support Forms

Form/Template
6/29/2021

This is a fillable and printer-friendly version of the forms available in the "Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans."

AFMES Form 18: Forensic Toxicology Analysis Request

Form/Template
6/14/2021

Use this form to obtain information/specimens needed to evaluate and document forensic toxicological testing.

AFMES Form 25: Histology Request and Specimen Storage

Form/Template
6/10/2021

Use this form to obtain information/specimens needed for histology tissue processing and/or specimen storage.

AFMES Form 3: Autopsy Request

Form/Template
6/9/2021

Use this form to request for an autopsy report and supplemental information

TCCC ASM CM Student Registration Form

Form/Template
4/7/2021

Students must complete this form to register for the course. All forms are emailed to the DMRTI TCCC Section for processing.

DHA Form 207: COVID-19 Vaccine Screening and Immunization Document, v25

Form/Template
3/25/2021

The purpose of this form is to determine if the COVID-19 vaccine can be administered to the patient. (v25, May 2023)

Sample WISDOM Agenda 5 Day

Form/Template
2/11/2021

aCME Disclosure FY20 Fillable

Form/Template
1/29/2021

Instructor CME Disclosure form

Research Repository Template

Form/Template
1/20/2021

The RRT asks researchers whether they intend to put data into a repository, and if yes, what data and under what governance terms.

EWSC Student Enrollment Form

Form/Template
1/8/2021

Fillable student enrollment form for EWSC registration.

JOP Nomination Form

Form/Template
11/24/2020

Student/nominee JOP course request form.

DHA Privacy Office Standard Contract Language

Form/Template
10/27/2020

This Section addresses the Contractor’s requirements under The Privacy Act of 1974 (Privacy Act), The Freedom of Information Act (FOIA), and The Health Insurance Privacy and Accountability Act (HIPAA) as set forth in applicable statutes, implementing regulations and DOD issuances.

HIPAA Safeguard Review of Non-Federal Systems (HSR)

Form/Template
10/1/2020

The HIPAA Safeguard Review of Non-Federal Systems (HSR) is used when data obtained through a DSAA will be stored, transmitted, processed, or otherwise maintained on a non-federal information system.

Dental Common Access System

Form/Template
9/2/2020

Dental Common Access System (DENCAS)

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Last Updated: July 11, 2023
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