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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 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

Refrigerator Temperature Log - Celsius

Form/Template
8/12/2019

Temperature log for refrigerators storing vaccines.

Recommended Content:

Vaccine Storage and Handling

Storage Unit Sticker Template

Form/Template
8/12/2019

Some resources you can use to protect your vaccine storage unit and warn staff to not turn off power to the unit.

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

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

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:

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

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.

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

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