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Form/Template
7/29/2014
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Medical Human Resources System - Internet (DMHRSi) system.
Form/Template
7/29/2014
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Designated Provider Health Care Delivery System (DPHCDS) system.
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.
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.
Form/Template
6/6/2014
This template is used to track plans of action and milestones regarding potential breaches.
Form/Template
6/1/2014
Use this form to bill for cosmetic surgery.
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.
Form/Template
5/19/2014
Used to obtain information/specimens needed to evaluate and document forensic DNA testing.
Form/Template
4/30/2014
The Data Request Template for General Extractions is required for a Data Sharing Agreement Application.
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.
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.
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.
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.
Form/Template
12/1/2013
Form used to request access to the collections at the National Museum of Health and Medicine.
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).
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Last Updated: October 22, 2021