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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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Recent Forms & Templates

Popular Forms & Templates

We found 624 items

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Form/Template
Jan. 1, 2024

Abbott Alinity CI v3x

.PDF | 745.59 KB

Privacy impact assessment for the Abbott Alinity CI-series is intended for In Vitro diagnostic use only. Alinity CI has a scalable design to provide full integration of clinical chemistry and immunoassay analysis.

Form/Template
Jan. 1, 2024

Tripler AMC MedCOI

.PDF | 734.96 KB

Privacy impact assessment for the Tripler AMC 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
Jan. 1, 2024

Fuji ASPIRE Cristalle FDR 3000AWS

.PDF | 567.83 KB

Privacy impact assessment for the Fuji ASPIRE Cristalle AWS is a series of integrated FFDM combining X-Ray systems with a-SE detectors and an Acquisition Workstation (AWS). The ASPIRE Cristalle creates digital mammography images by direct capture of X-Ray using the a-SE detector.

Form/Template
Dec. 21, 2023

Business Intelligence Common Services

.PDF | 664.47 KB

Privacy impact assessment for the Business Intelligence Common Services serves as the Defense Health Agency Solutions Delivery Division Common Services environment for Data Analytics, Business Intelligence and Reporting requirements at the departmental and enterprise level.

Form/Template
Dec. 21, 2023

Assistance Reporting Tool

.PDF | 673.60 KB

Privacy impact assessment for the Assistance Reporting Tool is a secure web-based system that captures authorizations and feedback on TRICARE related benefits. Customer service personnel use ART to document beneficiary questions and concerns related to TRICARE and how those issues are resolved.

Form/Template
Dec. 18, 2023

Enterprise Patient Queuing and Notification System

.PDF | 564.01 KB

Privacy impact assessment for the Enterprise Patient Queuing Notification System automates patient check-in during visits to Military Treatment Facilities and clinics.

Form/Template
Dec. 18, 2023

DOD Drug Demand Reduction Program MedCOI

.PDF | 731.07 KB

Privacy impact assessment for the DOD-Drug Demand Reduction Program-MedCOI enclave is not part of an MTF, but consists of hardware, software, and telecommunications architecture to provide forensic drug testing to DOD commands located globally.

Form/Template
Dec. 4, 2023

DelWorks DR Artpix Mobile EZ2GO

.PDF | 748.56 KB

Privacy impact assessment for the DelWorks DR ArtPix EZ2GO is a flexible high-resolution Digital Radiography (DR) system designed to provide fast and smooth radiography examinations of patient imaging.

Form/Template
Dec. 4, 2023

DHA E-Commerce System

.PDF | 642.38 KB

DHA E-Commerce System privacy impact assessment

Form/Template
Dec. 1, 2023

Nuclear Medicine Information System Biodose

.PDF | 747.26 KB

Privacy impact assessment for the Nuclear Medicine Information System Biodose. NMIS is an application hosted on a Virtual Machine Windows 2019 server. NMIS is only used by Radiology, particularly in the Nuclear Medicine Division, Radiation Safety, and National Intrepid Center of Excellence Nuclear Medicine.

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