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Military Health System

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Defense Health Agency Speaker Request Form

Form/Template
12/16/2016

Use this form to request a speaker from the Defense Health Agency. Try and submit your request as early as possible to allow our potential speakers time to coordinate their demanding schedules. 90 days of notice is a good rule of thumb, especially for events that require travel.

C4 Welcome Letter

Form/Template
11/2/2016

Welcome Letter for the DMRTI C4 Course

MTF NCPDP NPI Request Form

Form/Template
9/9/2016

Use this form to request a new NCPDP/NPI Number

MTF ePharmacy NCPDP NPI Request Form

Form/Template
9/9/2016

Use this form to requests a new ePharmacy NCPDP/NPI number

Vendor Information Form

Form/Template
7/27/2016

The Vendor Information Form provides a standard way to collect your ideas, problem statements, and/or proposed solution sets for defense health IT.

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Health Care Technology

MTF ePharmacy Demographic Change Request Form

Form/Template
7/7/2016

For assistance completing this form or any other related information, e-mail the DHA PASS general mailbox dha.jbsa.pharmacy.mbx.pass@mail.mil or call the DHA PASS at 1-866-275-4732 / (210) 536-6650, press option 1.

TRICARE Webinar Feedback

Form/Template
6/27/2016

Use this form to submit feedback about the webinar on June 22, 2016 titled, "An Overview of the TRICARE Retail Refunds Program Dispute Resolution Process."

Family Reference Collection Form

Form/Template
6/22/2016

This form is used to establish a DNA reference specimen repository and database of information from kindred family members of unaccounted for/unidentified service members or other individuals needing to be identified. DNA will be extracted from a biological specimen or personal effect and used in identifying human remains.

DVEIVR PIA

Form/Template
6/15/2016

Privacy Impact Assessment (PIA) Summary for Defense and Veterans Eye Injury and Vision Registry (DVEIVR)

MDR PIA

Form/Template
6/15/2016

Privacy Impact Assessment (PIA) Summary for the Military Health System (MHS) Data Repository (MDR)

MDR Export Transmittal Form

Form/Template
5/25/2016

MDR Export Transmittal Form. This needs to be filled out if you are exporting more than 10,000 records.

Recommended Content:

MDR Functional Specifications

UFBPA UFADP Appendix August 2016: Alcohol

Form/Template
5/6/2016

UF BPA and UF ADP Appendix for Alcohol Deterrents-Narcotic Antagonists

UFBPA UFADP Appendix August 2016: Acne

Form/Template
5/6/2016

UF BPA and UF ADP Appendix for Acne Agents-Topical Acne and Rosacea Agents

UFBPA UFADP Appendix August 2016: Migraine

Form/Template
5/6/2016

UF BPA and UF ADP Appendix for Migraine Agents-Triptans

Data Exchange Service_DES

Form/Template
5/2/2016

PIA Summary for the Data Exchange Service (DES)

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Last Updated: October 22, 2021
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