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USU Researchers Commended for Innovation, Leadership with 2021 MHSRS Awards
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Form/Template
4/10/2017
Defense Health Agency, Great Lakes Worksheet (DHA-GL Worksheet-01) This worksheet is used to confirm eligibility of Reserve Component Members
Form/Template
4/10/2017
Defense Health Agency - Great Lakes Worksheet (DHA-GL Worksheet-06) This form is used to request pre-authroization for surgical care from the DHA, Great Lakes.
Form/Template
4/6/2017
Please complete the TRICARE Retail Pharmacy Refunds Manufacturer Questionnaire and email to UFVARR_Requests@mail.mil.
Form/Template
1/30/2017
This template shall be used to notify the DHA Privacy and Civil Liberties Office (Privacy Office) that the Government Sponsor listed in an executed Data Sharing Agreement (DSA) has been replaced by a new Government Sponsor.
Form/Template
1/30/2017
This template shall be used to notify the DHA Privacy and Civil Liberties Office (Privacy Office) that the Applicant / Recipient listed in an executed Data Sharing Agreement (DSA) has been replaced by a new Applicant / Recipient.
Form/Template
1/30/2017
This template is for the sole purpose of certifying that data used in connection with a Data Sharing Agreement (DSA) that was executed with the DHA Privacy and Civil Liberties Office (Privacy Office) has been appropriately disposed of in a timely manner.
Form/Template
12/29/2016
Student enrollment form to register in the DMRTI EWSC Course
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.
Form/Template
11/2/2016
Welcome Letter for the DMRTI C4 Course
Form/Template
9/9/2016
Use this form to request a new NCPDP/NPI Number
Form/Template
9/9/2016
Use this form to requests a new ePharmacy NCPDP/NPI number
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.
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.
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."
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.
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Last Updated: September 13, 2022