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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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We found 532 items

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Form/Template
Jun 4, 2024

Quidel Sofia Analyzers Version 2X AI

.PDF | 651.70 KB

Privacy impact assessment for the Quidel Sofia Analyzers (AI) (Sofia Analyzers), an enterprise-wide information system, is a professional use laboratory small bench top analyzer using fluorescence detection to identify infectious diseases like Coronavirus Disease (COVID-19).

Form/Template
Jun 4, 2024

Philips IntelliVue Information Center iX C032697 AA

.PDF | 581.01 KB

Privacy impact assessment for the Philips Patient Information Center iX (PICiX) software application is to Receive, aggregate, process, distribute, and display physiologic waves, parameters, alarms and events at locations other than at the patient, for multiple patients.

Form/Template
Jun 4, 2024

MagView Mammography Information System MMIS

.PDF | 664.12 KB

Privacy impact assessment for the MagView Mammography Information System (MMIS) is a commercial-off-the-shelf (COTS) product. The Magview information software is an automated workflow efficiency tool used for mammography practice.

Form/Template
Jun 4, 2024

Medtronic StealthStation S8 AI

.PDF | 660.27 KB

Privacy impact assessment for the Medtronic StealthStation™ S8 surgical navigation system allows the clinician to precisely track the location of surgical instruments throughout a procedure.

Form/Template
Jun 4, 2024

Sysmex CS Win 10 Series Hemostasis Analyzers AI

.PDF | 558.85 KB

Privacy impact assessment for the Sysmex CS-Series is a medical device (a hemostasis system). It is made up of two components: an analyzer and an information processing unit (IPU).

Form/Template
Jun 4, 2024

Zeiss IOL Master 700 4X

.PDF | 735.99 KB

Privacy impact assessment for the IOL Master 700 is a non-invasive optical biometry instrument for visualization and measurement of ocular structures. The IOL Master 700 is the latest generation device in the IOL Master series.

Form/Template
Jun 4, 2024

42nd MDG Maxwell AFB MEDCOI

.PDF | 735.55 KB

Privacy impact assessment for the 42nd MDG Maxwell AFB_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
Jun 4, 2024

Longitudinal Natural Language Processing LNLP

.PDF | 784.22 KB

Privacy impact assessment for the Natural Language Processing (DoD NLP) application uses a Commercial off the shelf (COTS) Natural Language Processing (NLP) engine (Invenio™) along with Machine Learning (ML) to process free text, creating an “index” of the text in a way that allows for searching concepts with associated context from the original data.

Form/Template
Jun 4, 2024

BIO RAD BIOPLEX 2200 4x AI

.PDF | 569.11 KB

Privacy impact assessment for the BioPlex 2200 System is a fully automated, floor-standing, self-contained, immunoassay analyzer for multiplex assays that can generate clinical laboratory test results for autoimmune disease, infectious disease and vitamin D on demand. Reactions (antibody-antigen or antigen-antibody) occur on the surface of ...

Form/Template
Jun 4, 2024

IRadimed 3880 MRI Patient Monitoring System AI

.PDF | 739.70 KB

Privacy impact assessment for the 3880 MRI Patient Monitoring System, also referred to as the 3880, is a multi-parameter vital signs monitor designed for use in the Magnetic Resonance (MR) environment by trained healthcare professionals.

Form/Template
Jun 4, 2024

71st MDV Vance AFB MEDCOI

.PDF | 744.32 KB

Privacy impact assessment for the 71st MDG Vance AFB_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
Jun 4, 2024

Philips IntelliVue Series Patient Monitors AI

.PDF | 745.18 KB

Privacy impact assessment for the Philips IntelliVue Series Patient Monitors_AI monitors are indicated for use by healthcare professionals whenever there is a need for monitoring the physiological parameters of patients.

Form/Template
Jun 4, 2024

DiaSorin Liaison XL V4X

.PDF | 738.55 KB

Privacy impact assessment for the DiaSorin Liaison XL V4.X is a fully-automated continuous loading chemiluminescent immunoassay (CLIA) analyzer for in vitro diagnostic analysis on human serum or plasma

Form/Template
Jun 4, 2024

Carestream 9600 Panoramic Dental Xray Version 1X AI

.PDF | 749.90 KB

Privacy impact assessment for the Carestream 9600 Panoramic Dental Xray Version 1.X_AI _(CS9600) is an extra-oral system intended to produce two-dimensional and three-dimensional digital of the dento-maxillofacial, ENT (Ear, Nose and Throat), cervical spine and wrist regions at the direction of healthcare professionals as diagnostic support for ...

Form/Template
Jun 4, 2024

Keller ACH West Point MEDCOI

.PDF | 740.48 KB

Privacy impact assessment for the Keller ACH -West Point_MEDCOI Enclave consists of hardware, software, and telecommunications architecture to provide information services to the hospital and outpatient clinics located at Keller Army Community Hospital in West Point, NY.

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