Military Health System

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.

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.

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.