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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 two 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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Assistance Reporting Tool (ART)

Form/Template
3/21/2022

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

Armed Forces Billing and Collection Utilization Solution - Amazon Web Services

Form/Template
3/10/2022

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

Consolidated Information Center Data Warehouse

Form/Template
3/10/2022

The Consolidated Information Center (CIC) Data Warehouse is used to facilitate the Bureau of Medicine and Surgery's analytical capabilities across Navy Medicine to improve speed of decision making.

National Optronics 7Ex Optical Fabrication Edger

Form/Template
2/28/2022

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.

HIV Management Service (HMS)

Form/Template
2/28/2022

HIV Management Service (HMS) is a Private web-based information management system, owned, operated and maintained by the Navy Bloodborne Infection Management Center, used to conduct infectious disease-related administrative reporting, patient tracking, and allows Infectious Disease on-line transaction processing (OLTP) to access, validate, and conduct statistical analysis.

DHA Appointing Portal

Form/Template
2/28/2022

The DHA Appointing Portal is a locally developed web application system used to automate vaccine availability and appointment scheduling. It is an enterprise-wide system currently hosted at Madigan Army Medical Center and accessible through a Defense Health Agency (DHA) website.

Veterinary Services Systems Management (VSSM)

Form/Template
2/28/2022

The purpose of the Veterinary Services Systems Management (VSSM) system via the Remote Online Veterinary Record (ROVR) application is to record and maintain complete health care information to include treatment history and deployment status on all Government Owned Animals (GOA).

Medical Readiness Decision Support System (MRDSS)

Form/Template
2/28/2022

Medical Readiness Decision Support System (MRDSS) is an automated information system on the Global Information Grid (GIG) used by the Air Force Medical Services (AFMS) to manage readiness information in direct support of active Air Force units, Air National Guard, and Air Force Reserves, at fixed bases, and deployed locations during both peace and wartime operations

3D Bio CAD 3 Shape TRIOS 3

Form/Template
2/28/2022

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

Limited Duty Sailor Marine Readiness Tracker (LIMDU SMART)

Form/Template
2/28/2022

LIMDU SMART provides Navy and Marine Corps with real-time visibility of all personnel on limited duty status, capability to run reports on all aspects of Limited Duty (LIMDU) Program, and electronically manage process workflows.

DHA Form 236: Pediatric (5-11 years) COVID-19 Vaccine Screening and Immunization Documentation, v12

Form/Template
1/7/2022

This form is used to determine if the COVID-19 vaccine can be administered to the pediatric patient. (Version 12, May 2023)

DHA Form 46: Sign Language Interpreter Request

Form/Template
10/29/2021

The DHA Form 46 is used to document a patient’s surgical care and ensure that care adhered to the Military Health System’s surgical and procedural safety protocols.

DHA Form 31: Reasonable Accommodation Request

Form/Template
10/29/2021

DHA Form 31 will be used by DHA personnel to request reasonable accommodations for health, medical, and disability needs, and to document the action taken in response to their requests.

PSP Materials Account Registration Form

Form/Template
9/7/2021

Account registration form for PSP Education Materials Online Ordering System

TCCC ASM Student Registration v2

Form/Template
8/17/2021

Defense Medical Readiness Training Institute (DMRTI) TC3 ASM Course Manager Student Enrollment Form

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Last Updated: July 11, 2023
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