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Data Sharing Agreement Application (DSAA)

Form/Template
10/25/2019

The Data Sharing Agreement Application (DSAA) is used when requesting data from systems that are owned and/or managed by DHA.

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Submit a Data Sharing Application

Request for DoD P&T Committee Consideration of Potential Changes to the Uniform Formulary, Basic Core Formulary or Extended Core Formulary

Form/Template
10/4/2019

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.

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TRICARE Formulary

MHS GENESIS / Defense Healthcare Management System Modernization Electronic Health Record (DHMSM EHR)

Form/Template
9/30/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the MHS GENESIS / Defense Healthcare Management System Modernization Electronic Health Record (DHMSM EHR)

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Electronic Health Record: MHS GENESIS

Dental Imaging Collaborative Environment (DICE)

Form/Template
9/24/2019

This Air Force Medical Support Agency (AFMSA) Privacy Impact Assessment (PIA) summarizes the Dental Imaging Collaborative Environment (DICE) system.

TRICARE E-Commerce (TMA ECS)

Form/Template
9/24/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the TRICARE E-Commerce (TMA ECS) system.

Spectacle Request and Transmission System (SRTS)

Form/Template
9/20/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) describes the Spectacle Request and Transmission System (SRTS). The SRTS is a Government developed clinic and laboratory web-based application that serves as the sole electronic system for ordering and tracking military eyewear.

DHA-GL Worksheet 07: DVA/DoD MOA Initial Referral & Authorization for SCI-TBI-Blind Rehab

Form/Template
8/29/2019

Used to collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.

DHA-GL Worksheet 07a: DVA/DoD MOA Continued Stay for SCI-TBI-Blind Rehab

Form/Template
8/29/2019

To collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.

DHA-GL Worksheet 08: DVA/DoD MOA SCI-TBI-Blind DME Request Worksheet

Form/Template
8/29/2019

To collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.

DHA-GL Worksheet 07: DVA/DoD MOA Initial Referral & Authorization for SCI-TBI-Blind Rehab STAR Program

Form/Template
8/29/2019

Used to collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program.

DHA-GL: How to Submit Discharge Summary notification

Form/Template
8/29/2019

This process guides references how to submit Discharge Summary notification from Inpatient or Outpatient Medical Care at a VA Facility under DVA/DoD Memorandum of Agreement (MOA) for Active Duty Service Members with SCI, TBI and/or Blind Diagnoses to Defense Health Agency Great Lakes DHA-GL.

DHA-GL: How to Submit Request for Durable Medical Equipment Pre- Authorization

Form/Template
8/29/2019

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 DVA/DoD Memorandum of Agreement (MOA) for Active Duty Service Members with SCI, TBI and/or Blind Diagnoses to Defense Health Agency Great Lakes DHA-GL.

CIS Essentris PIA

Form/Template
8/19/2019

This Privacy Impact Assessment (PIA) documents compliances for CIS-Essentris

Storage Unit Sticker Template

Form/Template
8/12/2019

Some resources you can use to protect your vaccine storage unit and warn staff to not turn off power to the unit.

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Vaccine Storage and Handling

Theater Medical Information Program-Joint Composite Health Care System Caché (TC2).

Form/Template
8/5/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Theater Medical Information Program-Joint Composite Health Care System Caché (TC2).

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