AGFA NX Family of Systems (CR/DR) vNX27_A&I
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.
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Form/Template
April 23, 2015
Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE)
.PDF |
194.39 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) system.
Form/Template
April 17, 2015
Defense Medical Accessions Computing System (DMACS)
.PDF |
102.71 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Medical Accessions Computing System (DMACS) system.
Form/Template
April 6, 2015
Fraud and Abuse Correspondence Tracking System (FACTS)
.PDF |
229.61 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Fraud and Abuse Correspondence Tracking System (FACTS) system.
Form/Template
Feb. 9, 2015
Epidemiology Laboratory Service Supply Order Form
.PDF |
175.03 KB
Submit this form to order Epidemiology Laboratory Service supplies.
Form/Template
Feb. 4, 2015
Fuji CR/DR Family on FDX Console
.PDF |
53.65 KB
This Air Force Medical Support Agency (AFMSA) Privacy Impact Assessment (PIA) summarizes the Fuji CR/DR Family on FDX Console system.
Form/Template
Jan. 16, 2015
Medical Readiness Decision Support System (MRDSS)
.PDF |
95.71 KB
This Air Force Medical Support Agency (AFMSA) Privacy Impact Assessment (PIA) summarizes the Medical Readiness Decision Support System (MRDSS) system.
Form/Template
Jan. 16, 2015
WHASC FileNet P8
.PDF |
98.33 KB
This Air Force Medical Support Agency (AFMSA) Privacy Impact Assessment (PIA) summarizes the WHASC FileNet P8 system.
Form/Template
Dec. 11, 2014
International SOS (Intl.SOS) Enrollment Image Management System (EIMS)
.PDF |
68.78 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the International SOS (Intl.SOS) Enrollment Image Management System (EIMS) system.
Form/Template
Nov. 3, 2014
Health Information Privacy HIPAA Complaint Form
.PDF |
363.14 KB
The Health Information Privacy HIPAA Complaint Form is used by DHA to proceed with a complaint. DHA uses the information provided to determine if DHA has jurisdiction and, if so, how to process your complaint.
Form/Template
July 29, 2014
DOD Women, Infants, and Children Overseas Participant Information Management System (WIC PIMS)
.PDF |
79.05 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the DOD Women, Infants, and Children Overseas Participant Information Management System (WIC PIMS) system.
Form/Template
July 29, 2014
TRICARE Managed Care System (TRIMACS)
.PDF |
70.05 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the TRICARE Managed Care System (TRIMACS) system.
Form/Template
July 29, 2014
Palmetto Government Benefits Administrator (PGBA)
.PDF |
70.70 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Palmetto Government Benefits Administrator (PGBA) system.
Form/Template
July 29, 2014
Defense and Veterans Eye Injury and Vision Registry (DVEIVR)
.PDF |
72.81 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense and Veterans Eye Injury and Vision Registry (DVEIVR) system.
Form/Template
July 29, 2014
Theater Medical Data Store (TMDS)
.PDF |
69.44 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Theater Medical Data Store (TMDS) system.
Form/Template
July 29, 2014
HA/TMA Communications ListServ (GovDelivery)
.PDF |
75.75 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the HA/TMA Communications ListServ (GovDelivery) system.
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