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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 five 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.

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We found 527 items

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Form/Template
Jun 4, 2024

General Electric Health Care GEHC Voluson E10

.PDF | 575.08 KB

Privacy impact assessment for the GEHC Voluson E10 is an Ultrasound physiologic clinic procedural mobile console, keyboard control panel, color LCD/TFT touch panel, color video display and optional image storage and printing devices component, DICOM capable system for MTF implementation(s).

Form/Template
Jun 4, 2024

Philips IntelliVue Information Center iX C032697 AA

.PDF | 581.01 KB

Privacy impact assessment for the Philips Patient Information Center iX (PICiX) software application is to Receive, aggregate, process, distribute, and display physiologic waves, parameters, alarms and events at locations other than at the patient, for multiple patients.

Form/Template
Jun 4, 2024

Protected Health Information Management Tool PHIMT

.PDF | 760.91 KB

Privacy impact assessment for the Protected Health Information Management Tool (PHIMT) provides the Military Health System (MHS) with a web-based application that simplifies and automates many of the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule.

Form/Template
Jun 4, 2024

Reynolds AHC Ft Sill MEDCOI

.PDF | 742.22 KB

Privacy impact assessment for Reynolds AHC -Ft Sill_MEDCOI enclave architecture consists of hardware, software, and telecommunications systems. The enclave includes user interfaces such as workstations and laptops and hosts office automation as well as medical systems and applications.

Form/Template
Jun 4, 2024

42nd MDG Maxwell AFB MEDCOI

.PDF | 735.55 KB

Privacy impact assessment for the 42nd MDG Maxwell AFB_MEDCOI enclave architecture consists of hardware, software, and telecommunications systems. The enclave includes user interfaces such as workstations and laptops and hosts office automation as well as medical systems and applications

Form/Template
Jun 4, 2024

Stryker Connected Operating Room Hub AA

.PDF | 742.21 KB

Privacy impact assessment for the Stryker Connected OR Hub is an Information Management System for capturing still images, recording live video, and displaying medical device data on connected displays.

Form/Template
Jun 4, 2024

Quidel Sofia Analyzers Version 2X AI

.PDF | 651.70 KB

Privacy impact assessment for the Quidel Sofia Analyzers (AI) (Sofia Analyzers), an enterprise-wide information system, is a professional use laboratory small bench top analyzer using fluorescence detection to identify infectious diseases like Coronavirus Disease (COVID-19).

Form/Template
Jun 4, 2024

Sysmex CS Win 10 Series Hemostasis Analyzers AI

.PDF | 558.85 KB

Privacy impact assessment for the Sysmex CS-Series is a medical device (a hemostasis system). It is made up of two components: an analyzer and an information processing unit (IPU).

Form/Template
Jun 4, 2024

Zeiss IOL Master 700 4X

.PDF | 735.99 KB

Privacy impact assessment for the IOL Master 700 is a non-invasive optical biometry instrument for visualization and measurement of ocular structures. The IOL Master 700 is the latest generation device in the IOL Master series.

Form/Template
Jun 4, 2024

Medtronic StealthStation S8 AI

.PDF | 660.27 KB

Privacy impact assessment for the Medtronic StealthStation™ S8 surgical navigation system allows the clinician to precisely track the location of surgical instruments throughout a procedure.

Form/Template
Jun 4, 2024

MagView Mammography Information System MMIS

.PDF | 664.12 KB

Privacy impact assessment for the MagView Mammography Information System (MMIS) is a commercial-off-the-shelf (COTS) product. The Magview information software is an automated workflow efficiency tool used for mammography practice.

Form/Template
Jun 4, 2024

Longitudinal Natural Language Processing LNLP

.PDF | 784.22 KB

Privacy impact assessment for the Natural Language Processing (DoD NLP) application uses a Commercial off the shelf (COTS) Natural Language Processing (NLP) engine (Invenio™) along with Machine Learning (ML) to process free text, creating an “index” of the text in a way that allows for searching concepts with associated context from the original data.

Form/Template
Jun 4, 2024

Abbott EP Cardiac Mapping System V1x AI

.PDF | 748.57 KB

Privacy impact assessment for the Abbott EP (electrophysiology) Cardiac Mapping System V1.x_AI consists of the EP Workmate and the next generation Claris Workmate. The Workmate is a fully computerized system for capturing and measuring physiological data in the clinical EP laboratory.

Form/Template
Jun 4, 2024

IRadimed 3880 MRI Patient Monitoring System AI

.PDF | 739.70 KB

Privacy impact assessment for the 3880 MRI Patient Monitoring System, also referred to as the 3880, is a multi-parameter vital signs monitor designed for use in the Magnetic Resonance (MR) environment by trained healthcare professionals.

Form/Template
Jun 4, 2024

BIO RAD BIOPLEX 2200 4x AI

.PDF | 569.11 KB

Privacy impact assessment for the BioPlex 2200 System is a fully automated, floor-standing, self-contained, immunoassay analyzer for multiplex assays that can generate clinical laboratory test results for autoimmune disease, infectious disease and vitamin D on demand. Reactions (antibody-antigen or antigen-antibody) occur on the surface of ...

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