This template shall be used to renew an executed Data Sharing Agreement (DSA) that incorporates an approved Data Sharing Agreement Application (DSAA). Submit this completed request or questions to the DHA Privacy and Civil Liberties Office (Privacy Office) at dha.ncr.j-6.mbx.dsa-mail@health.mil.

Privacy Impact Assessment

TRICARE Dispute Resolution Form for manufacturers. For use on resubmitted rejected disputes.

DHA Form 249: Pharmacy Data Warehouse Data Report Request Form. To download the form , right-click and select "Save Link As". To open the form, right-click and select "Open with Adobe Acrobat."

Web MEDCASE Requirements and Execution 1.x A&A 2990 privacy impact assessment

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 ...

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Assistance Reporting Tool (ART) system.

The Armed Forces Billing and Collection Utilization Solution (ABACUS) provides a standard patient accounting system for health care billing practices.

3D Bio CAD 3 Shape TRIOS 3 (“TRIOS 3”) Wireless Scanner captures digital images of the teeth used to design and fabricate dental appliances.

7Ex is a single purpose programmable instrument that edges high base lenses using the 7Ex's unique cutter design. Performs drilling and grooving in one process with the flexibility to process all bevel cutting types.

This is a fillable and printer-friendly version of the forms available in the "Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans."

Instructor CME Disclosure form

The RRT asks researchers whether they intend to put data into a repository, and if yes, what data and under what governance terms.

This Section addresses the Contractor’s requirements under The Privacy Act of 1974 (Privacy Act), The Freedom of Information Act (FOIA), and The Health Insurance Privacy and Accountability Act (HIPAA) as set forth in applicable statutes, implementing regulations and DOD issuances.