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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 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

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Form/Template
Sept. 15, 2015

Annual Review of Compliance Program Effectiveness Checklist

.DOCX | 26.92 KB

The UBO Compliance Officer will regularly review the implementation and execution of the compliance program elements. This review will be conducted as least annually and will include an assessment of each of the basic elements individually, as well as the overall success of the program. It will help identify any weaknesses in your compliance program ...

Form/Template
Sept. 15, 2015

UBO Compliance Audit Checklist

.DOC | 477.00 KB

This Compliance Audit Checklist Template is an element of our MTF’s Internal Control Review and is part of your compliance program. It covers the basic points of TPC, MSA, and MAC programs. It can also be used in business case analysis/reengineering initiatives for the Uniform Business Office.

Form/Template
Aug. 11, 2015

Coding and Compliance Editor (CCE)

.PDF | 166.39 KB

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Coding and Compliance Editor (CCE) system.

Form/Template
July 28, 2015

PEPR Account Activation Request Form

.PDF | 6.81 MB

This form is required for all users to complete prior to receiving access to the Patient Encounter and Reporting (PEPR) application.

Form/Template
July 20, 2015

Audio Metric Database System (AUDBASE) 2.3

.PDF | 61.15 KB

This Air Force Medical Support Agency (AFMSA) Privacy Impact Assessment (PIA) summarizes the Audio Metric Database System (AUDBASE) 2.3 system.

Form/Template
July 20, 2015

STARS

.PDF | 58.44 KB

This Air Force Medical Support Agency (AFMSA) Privacy Impact Assessment (PIA) summarizes the STARS system.

Form/Template
May 20, 2015

Consent Checklist

.PDF | 106.87 KB

DOD Directive 3216.02 defines research involving a human being as an experimental subject as an activity, for research purposes, where there is an intervention or interaction with a human being for the primary purpose of obtaining data regarding the effect of the intervention or interaction. Examples of interventions or interactions include, but are ...

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