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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 477 items

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Form/Template
Apr 24, 2024

Carestream DRX Family of Products 2X AI

.PDF | 746.90 KB

The Carestream ImageView Radiology product family provides scalable x-ray acquisition solutions for low volume clinics up to high volume multi-site institutions.

Form/Template
Apr 24, 2024

Draeger Infinity M300 VG2 x AI

.PDF | 729.78 KB

Privacy Impact assessment that is the Draeger Infinity M300 VG2.x_AI (Draeger M300) is a patient-worn transceiver that uses the Infinity Central Station as the primary patient monitoring display and primary alarm source.

Form/Template
Apr 24, 2024

Abbott i STAT1 AI

.PDF | 741.41 KB

Privacy impact assessment The Abbott i-STAT1 System is an advanced hand-held and test cartridge blood analysis system that delivers laboratory quality results.

Form/Template
Apr 24, 2024

Beckman Coulter DXH900 V1X and DXH690 T AI

.PDF | 764.46 KB

The Beckman Coulter DXC 700 AU Chemical Analyzer 1 V1.X_AI measures analytes in samples, in combination with appropriate reagents, calibrators, quality control samples, and other accessories.

Form/Template
Apr 24, 2024

Beckman Coulter DXUM iQ 200 Elite

.PDF | 749.73 KB

Beckman Coulter DXUM iQ 200 Elite is a urinalysis machine. The DXUM iQ Elite 200 connects two instruments which are the AX-4030 and the iQ 200 via unique serial RS-232 connection and is intended to connect to the Laboratory Information System using a serial connection.

Form/Template
Apr 12, 2024

Sysmex Caresphere Workflow Solution

.PDF | 732.66 KB

Privacy Impact assessment that is a data management and processing system for Sysmex hematology, urinalysis and chemistry medical devices. Caresphere WS is a management system that offers a comprehensive analyzer and result management tool.

Form/Template
Apr 12, 2024

MEDCOI Quantico

.PDF | 737.70 KB

The MEDCOI Quantico consists of hardware, software, and telecommunications architecture to provide information services.

Form/Template
Apr 12, 2024

Global Teleconsultation Portal

.PDF | 746.74 KB

Global Teleconsultation Portal is Defense Health Agency's enterprise asynchronous (store & forward) platform used for provider-to-provider teleconsultation and when required, aeromedical evacuation case management.

Form/Template
Apr 12, 2024

Spectacle Request and Transmission System

.PDF | 792.81 KB

The Spectacle Request and Transmission System is a Government developed clinic and laboratory web-based application that serves as the sole electronic system for ordering and tracking military eyewear.

Form/Template
Apr 12, 2024

Patient Safety Reporting PSR

.PDF | 748.21 KB

Patient Safety Reporting is a Public-key infrastructure/Common Access Card compliant Commercial Off-the-Shelf automated information syst+A1:B11em for patient safety event reporting, event investigation/management, and data analysis.

Form/Template
Apr 12, 2024

Medical Department Activity Bavaria

.PDF | 728.38 KB

Privacy impact assessment enclave architecture consists of hardware, software, and telecommunications systems.

Form/Template
Apr 12, 2024

48th MDG RAF Lakenheath MEDCOI

.PDF | 741.72 KB

The 48th Medical Group Royal Air Force Lakenheath_Medical Community of Interest Local Area Network consists of hardware, software, and telecommunications architecture to provide information services to the hospital and outpatient clinics located at RAF Lakenheath, United Kingdom.

Form/Template
Apr 12, 2024

45th MDG Patrick AFB MEDCOI

.PDF | 741.24 KB

45th MDG Patrick AFB MEDCOI Enclave will provide core services to the Medical Community of Interest to include collections of patient's personally identifiable information, protected health information, storage arrays, networking infrastructure, backup and recovery devices, virtual server infrastructure, physical servers, file and print servers, local ...

Form/Template
Apr 12, 2024

Naval Medical Research Center MEDCOI

.PDF | 730.93 KB

The research enclave architecture consists of hardware, software, and telecommunications systems and is s located within three Local Core Infrastructure including Forest Glen in Silver Spring, Maryland, Fort Detrick in Frederick, Maryland and Walter Reed National Military Medical Center in Bethesda Maryland.

Form/Template
Apr 12, 2024

319th MDG Grand Forks AFB MEDCOI

.PDF | 743.93 KB

319th MDG Grand Forks AFB Medical Community of Interest enclave provides core services to the medical center's enterprise to include collections of storage arrays, networking infrastructure, backup and recovery devices, virtual server infrastructure, physical servers, file and print servers, local applications, and Commercial-Off-The-Shelf based ...

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