Sep
21
Prevent Serious Illness, Get Updated COVID-19 and Flu Vaccines
The fall and winter months tend to be the time when most people are sick with respiratory illnesses, like the cold, flu and COVID-19, though these can happen anytime of the year.
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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.
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Privacy Impact Assessment for the DoDSER 2.0, surveillance system designed to gather standardized risk and protective factor information for suicide events across multiple domains.
Privacy Impact Assessment for the Financial Management Information System, an integrated resource execution system that enables the Military Health System Resource Management users to rapidly compile operational data from disparate internal and external legacy financial, acquisition, logistics, personnel, and payroll data sources.
Privacy Impact Assessment for AHLTA, a fully integrated health care information system used in Department of Defense Military Treatment Facilities and clinics.
Form for providers to refer patients who were exposed to smallpox vaccine while pregnant to the Smallpox Vaccine in Pregnancy Registry.
Pentax endoPRO iQ is a video and imaging application and the primary function is the maintenance/storage of patient and procedure data.
This form is used to provide the Defense Medical Readiness Training Institute (DMRTI) with information required to complete course registration in order to provide student and DMRTI full course attendance as well as the awarding of Continuing Education credit (CME/CNE).
Recommended Content:
TRICARE Dispute Resolution Form for manufacturers. For use on resubmitted rejected disputes.
The Web Medical Care Support Equipment (MEDCASE) Requirements and Execution (WebMRE) version 1.x system is a database and web application that is developed for the Defense Health Agency's (DHA's) Integrated Clinical Systems Program Management Office (ICS PMO). The WebMRE system is a Platform as a Service (PaaS) hosted on the DHA's Data Center Operations Branch (DCOPS) virtual environment. The WebMRE system is designed to provide detailed information, requirements data, and execution status to assist in the management and control of the MEDCASE/Super Capital Expense Equipment Program (SuperCEEP). WebMRE system will provide detailed information of Medical Device Equipment located in the Army's Medical Treatment Facilities (MTF’s) to assist with the requirements generation, life-cycle management and Planning, Programming, Budgeting and Execution (PPBE) process for Army Medical Equipment and general users. The system was a legacy application that was developed in Oracle 11g and was upgraded to Oracle 12c. The system was migrated from legacy application of Cold Fusion to ASP.NET MVC 5 Framework. The WebMRE System application is a database to manage the data captured via user interface. Front end of the application is developed using ASP.NET. The backend will use ORACLE 12c.
Temperature log for freezers storing vaccines, with form for recording vaccine storage troubleshooting.
Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.
The 59th MDW Wilford Hall (WHEN)_MEDCOI is also known as Wilford Hall Ambulatory Surgical Center (WHASC) Site and Wilford Hall Enterprise Network (WHEN) is an outpatient Medical Treatment Facility (MTF) supporting over 240,000 enrolled Tri-Service Beneficiaries and more than 6,000 military members, civilian personnel, residents, and students. The WHEN Enclave consists of End User Devices (EUDs), switches, appliances, and the data center. The WHEN provides all environmental controls such as light, power, Heating Ventilation Air Conditioning, and physical security for the data center. Co-located and Managed Co-located systems within the data center include systems and applications that contain Protected Health Information (PHI) and Personally Identifiable Information (PII) data. Data Network Connectivity (DNC), Enterprise Management System (EMS), and the Network Protection Suite are services controlled and managed by DHA and are not included in the authorization boundary.
The appearance of hyperlinks does not constitute endorsement by the Department of Defense of non-U.S. Government sites or the information, products, or services contained therein. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website.