On this page, you will find various forms that Defense Health Agency uses to support its programs. Please scroll down the page or use the search box to find specific forms and templates.
Please note that files more than two years old may not be compliant with Section 508 of the Rehabilitation Act. If you need an accessible version of a particular file, please contact us and we will provide one for you.
Showing results 1 - 15
Page 1 of 19
Form/Template
8/18/2015
Reserve/National Guard units can submit this form to request a briefing from their regional contractor each year.
Form/Template
8/18/2015
Reserve/National Guard units can submit this form to request a briefing from their regional contractor each year.
Form/Template
8/18/2015
Reserve/National Guard units can submit this form to request a briefing from their regional contractor each year.
Form/Template
8/18/2015
Submit this form if you believe that one or more of the exceptions to the eligibility criteria for TRICARE Prime Remote enrollment are met. Only service members or unit commanders can submit this form.
Form/Template
8/18/2015
Submit this form if you believe that one or more of the exceptions to the eligibility criteria for TRICARE Prime Remote enrollment are met. Only service members or unit commanders can submit this form.
Form/Template
8/18/2015
Submit this form if you believe that one or more of the exceptions to the eligibility criteria for TRICARE Prime Remote enrollment are met. Only service members or unit commanders can submit this form.
Form/Template
7/1/2011
This form is for institutional providers to apply for enrollment in the Medicare program or make a change in their enrollment information.
Form/Template
1/30/2017
The Data Sharing Agreement Application (DSAA) is used when requesting data from systems that are owned and/or managed by DHA.
Recommended Content:
Submit a Data Sharing Application
Form/Template
1/30/2017
This template is used to request a 30 day extension in order to continue to use the data in accordance to the executed Data Sharing Agreement (DSA).
Recommended Content:
Submit a Data Sharing Application
Form/Template
1/30/2017
The Data Sharing Agreement Modification Request template is used when requesting the modification of an executed DSA.
Recommended Content:
Submit a Data Sharing Application
Form/Template
1/30/2017
The Data Sharing Agreement Renewal Request template is used when requesting the renewal of an executed DSA.
Recommended Content:
Submit a Data Sharing Application
Showing results 1 - 15
Page 1 of 19