Military Health System

AFMES Form 25: Histology Request and Specimen Storage

Use this form to obtain information/specimens needed for histology tissue processing and/or specimen storage.

AFMES Form 3: Autopsy Request

Use this form to request for an autopsy report and supplemental information

TCCC ASM CM Student Registration Form

Students must complete this form to register for the course. All forms are emailed to the DMRTI TCCC Section for processing.

DHA Form 207: COVID-19 Vaccine Screening and Immunization Document, v25

The purpose of this form is to determine if the COVID-19 vaccine can be administered to the patient. (v25, May 2023)

Emergency Vaccine Retrieval and Storage Plan Worksheet

Sample WISDOM Agenda 5 Day

aCME Disclosure FY20 Fillable

Instructor CME Disclosure form

Research Repository Template

The RRT asks researchers whether they intend to put data into a repository, and if yes, what data and under what governance terms.

EWSC Student Enrollment Form

Fillable student enrollment form for EWSC registration.

JOP Nomination Form

Student/nominee JOP course request form.

DHA Privacy Office Standard Contract Language

This Section addresses the Contractor’s requirements under The Privacy Act of 1974 (Privacy Act), The Freedom of Information Act (FOIA), and The Health Insurance Privacy and Accountability Act (HIPAA) as set forth in applicable statutes, implementing regulations and DOD issuances.

HIPAA Safeguard Review of Non-Federal Systems (HSR)

The HIPAA Safeguard Review of Non-Federal Systems (HSR) is used when data obtained through a DSAA will be stored, transmitted, processed, or otherwise maintained on a non-federal information system.

Dental Common Access System

Dental Common Access System (DENCAS)

MDR Special Justification Form

Military Health System Data Repository (MDR) Special Justification Form. MDR Users will use this to request access to special tables in the MDR.

DD Form 3111: Routine Immunization Screening Form: Adults

A screening checklist for contraindications to vaccines for adults.