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United Concordia Companies Inc. (UCCI) Active Duty Dental Program (ADDP)

Form/Template
7/29/2014

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the United Concordia Companies Inc. (UCCI) Active Duty Dental Program (ADDP) system.

Defense Medical Human Resources System - Internet (DMHRSi)

Form/Template
7/29/2014

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Medical Human Resources System - Internet (DMHRSi) system.

KARL STORZ Integrated Operating Room (i-OR) System with LiveData

Form/Template
7/29/2014

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the KARL STORZ Integrated Operating Room (i-OR) System with LiveData system.

Plan of Action and Milestone Template

Form/Template
6/6/2014

This template is used to track plans of action and milestones regarding potential breaches.

Recommended Content:

Breach Prevention and Response

Cosmetic Surgery Superbill 2014

Form/Template
6/1/2014

Use this form to bill for cosmetic surgery.

Formal Appeal Request

Form/Template
6/1/2014

Defense Health Agency - Great Lakes Worksheet (DHA-GL Worksheet-03) Complete this form when submitting a formal appeal for denied medical claims or denied pre-authorization requests by the DHA, Great Lakes.

Forensic DNA Specimen Analysis Request

Form/Template
5/19/2014

Used to obtain information/specimens needed to evaluate and document forensic DNA testing.

Data Request Template (DRT) - Access by Login (all DHA Systems)

Form/Template
4/30/2014

The Data Request Template for Access by Login for all DHA Systems is required for a Data Sharing Agreement Application.

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Data Sharing Agreements

General Data Request Template (DRT) Extractions (for all other DHA Systems)

Form/Template
4/30/2014

The Data Request Template for General Extractions is required for a Data Sharing Agreement Application.

Recommended Content:

Data Sharing Agreements

MHS IM-IT Submissions Form Instructions

Form/Template
4/16/2014

Instructions for completing the MHS IM-IT Submissions Form. The form is used to submit an idea that fosters a change to an IM/IT capability, policy/process, or system.

Recommended Content:

Health Care Administration & Operations | Health Care Technology

DHA Small Vendor Business Profile List

Form/Template
4/8/2014

Defense Health Agency (DHA) Office of Small Business Programs (OSBP) uses the System for Award Management (SAM), as well as other government-wide procurement systems, such as the Federal Procurement Data Systems (FPDS), to compile data on Small Business (SB) vendors. The information gathered assists in identifying vendors, their capabilities, and other information necessary for potential contracting opportunities with DHA. The below information captures such information and is used only to assist within the identification process. Completing and submitting this form is voluntary. DHA does not guarantee that your company will be selected for, or awarded a contract to provide products or services.

Recommended Content:

Small Business Programs | Small Business Programs

Researcher Responsibilities

Form/Template
2/27/2014

The Researcher Responsibilities Form ensures that all investigators conducting Department of Defense (DOD) research involving human participants understand and comply with all the relevant federal and DOD regulations, including Human Protections, records management, and the Health Insurance Portability and Accountability Act (HIPAA). The form also includes provisions related to any DOD biomedical research to comply with FDA regulations.

Recommended Content:

Research & Innovation

Collections Access Request

Form/Template
12/1/2013

Form used to request access to the collections at the National Museum of Health and Medicine.

MHS NoPP Acknowledgement Form

Form/Template
10/1/2013

The MHS Notice of Privacy Practices (NoPP) describes how medical information about you may be used and disclosed and how you can get access to this information. This form serves as an acknowledgement to patients and beneficiaries that they have received the MHS NoPP. The template is sized to scale and can be reproduced locally on Avery Label #5163, 5263, 2163, 5923, 5963 (size: 2 inches x 4 inches).

Recommended Content:

How HIPAA Protects You | HIPAA Compliance within the MHS | MHS Notice of Privacy Practices

Neuroimaging following TBI in non deployed setting

Form/Template
7/8/2013

The guidance contained in this CR represents a review of currently published literature and expert contributions obtained by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) in collaboration with clinical subject matter experts representing the Services, Department of Veterans Affairs (VA), academic, research and civilian sectors.

Recommended Content:

Health Readiness & Combat Support | Public Health | Disability Evaluation | Traumatic Brain Injury Center of Excellence
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Last Updated: October 22, 2021
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