Defense Health Agency Forms and Office Locations – Government Agency in U.S.

The Defense Health Agency supports uniformed services health care, including the TRICARE health plan.

81 - 100 of 298 forms

Form Title	Topics
Department of Defense Suicide Event Report
Deployed Tele-Radiology System (DTRS)/Theater Imaging Repository (TIR)
Designated Provider Health Care Delivery System
DHA Appointing Portal
DHA Data Element Request Summary
DHA DSA Application - Data Sharing Agreement
DHA DSAA Prerequisite Checklist - Data Sharing Agreements
DHA DSA Modification Request - Data Sharing Agreements
DHA Form 207: COVID-19 Vaccine Screening and Immunization Document, v23
DHA Form 236: Pediatric (5-11 years) COVID-19 Vaccine Screening and Immunization Documentation, v10
DHA Form 249: Pharmacy Data Warehouse Data Report Request Form
DHA Form 31: Reasonable Accommodation Request
DHA Form 46: Sign Language Interpreter Request
DHA-GL: How to Submit Discharge Summary notification
DHA-GL: How to Submit Request for Durable Medical Equipment Pre-Authorization
DHA-GL Worksheet-01: Medical Eligibility Verification
DHA-GL Worksheet-06: Surgical Pre-Authorization Request
DHA-GL Worksheet 07a: DOD/VA MOA Continued Stay for SCI-TBI-Blind Rehab
DHA-GL Worksheet 07: DVA/DOD MOA Initial Referral & Authorization for SCI-TBI-Blind Rehab
DHA-GL Worksheet 07: DVA/DOD MOA Initial Referral & Authorization for SCI-TBI-Blind Rehab STAR Program

1 contact point

Address:
7700 Arlington Boulevard
Suite 5101
Falls Church, VA 22042-5101

Phone numbers: