Military Health System

DD Form 3110: Routine Immunization Screening Form: Pediatric

A screening checklist for contraindications to vaccines for children and teens.

Smallpox Vaccine Screening Form

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.

AFRSSIR Supply Order Request

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

DMRTI JOP Student Nomination_JAN20

Student nomination form for both JMOCs and JMPT.

Form 543

DMRTI JOP Student Nomination

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

EACE Data Request Form

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

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

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

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

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

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.

MHS GENESIS / Defense Healthcare Management System Modernization Electronic Health Record (DHMSM EHR)

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the MHS GENESIS / Defense Healthcare Management System Modernization Electronic Health Record (DHMSM EHR)

Dental Imaging Collaborative Environment (DICE)

This Air Force Medical Support Agency (AFMSA) Privacy Impact Assessment (PIA) summarizes the Dental Imaging Collaborative Environment (DICE) system.

TRICARE E-Commerce (TMA ECS)

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the TRICARE E-Commerce (TMA ECS) system.

Spectacle Request and Transmission System (SRTS)

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.