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Forms & Templates

On this page, you will find various forms that Military Health System 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.

Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) system.

Electronic Institutional Review Board (EIRB)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Electronic Institutional Review Board (EIRB) system.

Defense Occupational and Environmental Health Readiness System - Hearing Conservation (DOEHRS-HC)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Occupational and Environmental Health Readiness System - Hearing Conservation (DOEHRS-HC) system.

Armed Forces Billing And Collection Utilization Solution - Amazon Web Services (ABACUS-AWS)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Armed Forces Billing and Collection Utilization Solution (ABACUS) system.

Workload Management System for Nursing-Internet (WMSNi)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Workload Management System for Nursing-Internet (WMSNi) system.

Recommended Content:

Privacy Impact Assessments

Transfusion -Enterprise Clinical Audiology Application (ECAA)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Transfusion -Enterprise Clinical Audiology Application (ECAA) system.

Recommended Content:

Privacy Impact Assessments

Donor -Enterprise Blood Management System (EBMS_D)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Donor -Enterprise Blood Management System (EBMS_D) system.

Medical Community of Interest (MedCOI)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Medical Community of Interest (MedCOI) system.

BUMED Manpower Information System II (BUMIS II)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the BUMED Manpower Information System II (BUMIS II) system.

Enterprise Blood Management System (EBMS_T)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Enterprise Blood Management System (EBMS_T) system.

Data Sharing Agreement Application (DSAA)

Form/Template
4/22/2019

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

Enterprise Blade System Military Health Service Virtual (MHSV)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Enterprise Blade System Military Health Service Virtual (MHSV) system.

Defense Medical Human Resources System - Internet (DMHRSi)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Medical Human Resources System - Internet (DMHRSi) system.

Offsite Clinic Vaccine Inventory Issue Return Receipt and Temp Log Celsius

Form/Template
3/15/2019

When transporting vaccine off-site, you must log their storage temperature every hour to ensure they are kept at the required temperature range for the duration of the event.

Recommended Content:

Vaccine Storage and Handling

Offsite Clinic Vaccine Inventory Issue Return Receipt and Temp Log Fahrenheit

Form/Template
3/15/2019

When transporting vaccine off-site, you must log their storage temperature every hour to ensure they are kept at the required temperature range for the duration of the event.

Recommended Content:

Vaccine Storage and Handling
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DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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