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Military Health System

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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.

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BUMED Manpower Information System II BUMIS II PIA

Form/Template
9/8/2022

BUMIS II provides an online inventory of personnel assigned to Navy Medicine. It includes demographics, education, health care specialty, additional qualifications, assignment and training skills. BUMIS II provides personnel planners at headquarters level with data about the medical personnel force that allows tracking and trends of gains, losses, and skill mix. The data is pivotal for the development of personnel strength plans, promotion plans, accession plans, and training plans and is also used for ad hoc queries responding to inquiries about Medical Department Officer force from both inside and outside the Navy Medical department.

Clinical Information System CIS Essentris Inpatient System PIA

Form/Template
9/8/2022

Clinical Information System (CIS)/Essentris® Inpatient System (hereinafter “CIS Essentris®”) the Military Health System (MHS) inpatient documentation solution is a comprehensive clinical documentation system for use in acute care hospitals. CIS/Essentris® enables continuous and automated clinical documentation and bedside point-of-care data capture. All inpatient clinical documentation is created and stored in CIS/Essentris®, the Composite Health Care System (CHCS), and bedside instruments. Clinical data may be aggregated, trended, and analyzed to manage care for a single patient or for an entire patient population. CIS/Essentris® also provides waveform documentation, graphical trending on patient parameters, a reference library, patient education materials, and various reporting capabilities such as change of shift reports, task lists, and administrative reports.

Workload Management System for Nursing Internet WMSNi PIA

Form/Template
9/8/2022

The purpose of the WMSNi system is to determine the nursing manpower requirements based upon patient care needs. The patient acuity data is collected to analyze nurse personnel requirements to meet the clinical needs of active service members, their families, retirees and other DOD personnel and dependents. WMSNi determines how many staff members are needed on a particular nursing unit to provide care during a 24-hour period. The resulting nursing manpower requirements are then documented in a table of distribution and allowances for use at the US Army Medical Command and its Medical Treatment Facilities (MTFs). Along with US Army MEDCOM and its MTFs, WMSNi is also being utilized at Walter Reed National Military Medical Center (WRNMMC), which is under the control of the Defense Health Agency (DHA).

Access Controls June 2022

Form/Template
8/31/2022

Access Controls Information Paper, updated June 2022

Best Practices for Safeguarding Laptops June 2022

Form/Template
8/31/2022

Information Paper on Best Practices for Safeguarding Laptops, updated June 2022

Best Practices for Verification of Identity June 2022

Form/Template
8/31/2022

Best Practices for Verification of Identity Information Paper, updated June 2022

Administrative Safeguards June 2022

Form/Template
8/31/2022

Administrative Safeguards Information Paper, updated June 2022

Military Health System Information Platform PIA

Form/Template
8/23/2022

The Military Health Systems (MHS) Information Platform (MIP) is a system containing multiple dashboards and databases that deliver enterprise clinical data capabilities. The capabilities provided by MIP are: Program Management; Data Warehousing; Application Portal; Infrastructure and Operations; Application Support; Business Intelligence; Analytics; Predictive Analytics; Legacy Data Consolidation Service; Defense Medical Surveillance System; and Corporate Executive Information System. Types of projects enabled by MIP include clinical dashboards, reports, data feeds, ad-hoc data requests, a data mart, medical history tracking of individual service members, and identification of service members at elevate risk of injury or mental health illness.

Naval Hospital Jacksonville (NHJAX) Enclave

Form/Template
8/12/2022

Complete this form for DOD information systems or electronic collections of information that collect, maintain, use, and/or disseminate PII about members of the public, Federal employees, contractors, or foreign nationals employed at U.S. military facilities internationally.

Composite Health Care System (CHCS)

Form/Template
8/12/2022

Composite Health care System (CHCS) is a fully integrated health care information system used in Department of Defense (DOD) Military Treatment Facilities (MTFs) and clinics. It is used to automate and integrate the functions performed by the hospital staff and to facilitate the delivery of health care and MTF's administration. Data elements include beneficiary information collected and used to support the delivery of health care to Defense Health Agency's (DHA) beneficiaries.

Enterprise Patient Queuing and Notification System (ePQNS)

Form/Template
7/21/2022

The Enterprise Patient Queuing Notification System (ePQNS) automates patient check-in during visits to Military Treatment Facilities (MTFs) and clinics. ePQNS provides real-time information to leadership to manage assets as wait-times increase or the situation dictates. It also allows MTFs to determine inefficiencies, identify best practices, and optimize clinic resources to improve each patient’s overall experience and reduce wait times.

Enterprise Blood Management System (EBMS) - Transfusion

Form/Template
7/12/2022

The purpose of Enterprise Blood Management System (EBMS)-Transfusion, formerly known as Blood Management Blood Bank Transfusion Service (BMBB/TS), is managing the blood transfusion aspect of the Armed Services Blood Program (ASBP), including blood records, blood orders, and transfusion patient information in the Continental United States and Outside Continental United States.

Steps to take for Potentially Compromised Vaccine Event

Form/Template
7/7/2022

TRICARE Online (TOL) System

Form/Template
5/3/2022

TRICARE Online (TOL) is a Department of Defense (DOD) Online Patient Portal (PP) which provides eligible beneficiaries with the following: access to Military Treatment Facilities' (MTFs) appointments, new prescription (Rx) fill and refills, health record data, service separation/retirement information as well as access to secure messaging (SM), and the Nurse Advice Line (NAL).

Centralized Credentials Quality Assurance System (CCQAS)

Form/Template
4/18/2022

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Centralized Credentials Quality Assurance System (CCQAS) system.

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Last Updated: July 11, 2023
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