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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.

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Offsite Clinic Vaccine Inventory Issue Return Receipt and Temp Log Fahrenheit

Form/Template
8/12/2019

When transporting vaccine off-site, you must log their storage temperature every hour to ensure they are kept at the required temperature range for the duration of the event.

Recommended Content:

Vaccine Storage and Handling

Emergency Vaccine Retrieval and Storage Plan Worksheet

Form/Template
8/12/2019

Recommended Content:

Vaccine Storage and Handling | Potential Vaccine Compromise Reporting

Freezer Temperature Log - Fahrenheit

Form/Template
8/12/2019

Temperature log for freezers storing vaccines.

Recommended Content:

Vaccine Storage and Handling

Refrigerator Temperature Log - Fahrenheit

Form/Template
8/12/2019

Monitoring the temperature of your vaccine storage unit is required at least twice a day, and should be logged using this form.

Recommended Content:

Vaccine Storage and Handling

Offsite Clinic FROZEN Vaccine Inventory Issue Return Receipt and Temp Log Celsius

Form/Template
8/12/2019

When transporting vaccine off-site, you must log their storage temperature every hour to ensure they are kept at the required temperature range for the duration of the event.

Recommended Content:

Vaccine Storage and Handling

Theater Medical Information Program-Joint Composite Health Care System Caché (TC2).

Form/Template
8/5/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Theater Medical Information Program-Joint Composite Health Care System Caché (TC2).

Defense Occupational and Environmental Health Readiness System - Industrial Hygiene (DOEHRS-IH)

Form/Template
7/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Occupational and Environmental Health Readiness System - Industrial Hygiene (DOEHRS-IH) system.

Air Force Medical Omnibus Web Applications (AFMOWAP)

Form/Template
7/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Air Force Medical Omnibus Web Applications (AFMOWAP)

Armed Forces Medical Examiner System Consultation Request Form

Form/Template
5/22/2019

Medical information received is considered during the consultative process and is used to form a database for education and research in pathology.

Recommended Content:

Office of the Armed Forces Medical Examiner | Armed Forces Medical Examiner System

AFRSSIR Supply Order Request

Form/Template
5/22/2019

Fill out this request to place and order with the Armed Forces Repository of Specimen Sample for the Identification of Human Remains

Recommended Content:

Armed Forces Repository of Specimen Samples for the Identification of Remains (AFRSSIR) | Specimen Collection Supplies Ordering Instructions | Armed Forces Medical Examiner System

Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) system.

Electronic Institutional Review Board (EIRB)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Electronic Institutional Review Board (EIRB) system.

Defense Occupational and Environmental Health Readiness System - Hearing Conservation (DOEHRS-HC)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Occupational and Environmental Health Readiness System - Hearing Conservation (DOEHRS-HC) system.

Armed Forces Billing And Collection Utilization Solution - Amazon Web Services (ABACUS-AWS)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Armed Forces Billing and Collection Utilization Solution (ABACUS) system.

Workload Management System for Nursing-Internet (WMSNi)

Form/Template
4/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Workload Management System for Nursing-Internet (WMSNi) system.

Recommended Content:

Privacy Impact Assessments
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DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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