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Military Health System

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Smallpox Vaccine Screening Form

Form/Template
3/2/2020

Each potential recipient of smallpox vaccine must complete this official screening form and it must be signed by a licensed health care provider prior to vaccination.

Recommended Content:

Smallpox (ACAM2000) | Smallpox Vaccine-Associated Adverse Events

AFRSSIR Supply Order Request

Form/Template
2/12/2020

Fill out this request to place and order with the Armed Forces Repository of Specimen Sample for the Identification of Human Remains

Recommended Content:

Armed Forces Medical Examiner System | Forensic Pathology Investigations (FPI) | DOD DNA Operations | Repository of Specimen Samples for the Identification of Remains

DMRTI JOP Student Nomination_JAN20

Form/Template
1/22/2020

Student nomination form for both JMOCs and JMPT.

Form 543

Form/Template
1/2/2020

DMRTI JOP Student Nomination

Form/Template
12/11/2019

Student nomination form for all DMRTI Joint Operations Program courses, to include, JMOC-B/A, JMPT, and JHOC.

AFHSB 501 Request Form

Form/Template
11/26/2019

Armed Forces Health Surveillance Branch (AFHSB) Epidemiology and Analysis AFHSB 501 Request Form

EACE Data Request Form

Form/Template
11/20/2019

Form for users to fill out to request information/data from EACE

DHA-GL Worksheet 41: DOD/VA MOA Inpatient-Outpatient Continued Stay Review

Form/Template
11/20/2019

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

DHA-GL Worksheet 07: DVA/DOD MOA Initial Referral & Authorization VAMC Richmond Only

Form/Template
11/14/2019

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

DHA-GL Worksheet : Discharge Summary

Form/Template
11/14/2019

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

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.

Recommended Content:

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)

Recommended Content:

MHS GENESIS: The Electronic Health Record

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.

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.

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.

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Last Updated: July 20, 2022
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