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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 468 items

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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

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

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 ...

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
Mar 27, 2024

Irwin Army Community Hospital ACH

.PDF | 737.82 KB

Privacy impact assessment for the Irwin Army Community Hospital ACH enclave architecture consists of hardware, software, and telecommunications.

Form/Template
Mar 27, 2024

51st MDG Osan AB MEDCOI

.PDF | 741.45 KB

Privacy impact assessment for the 51st MDG Osan Air Base MEDCOI enclave architecture consists of hardware, software, and telecommunications.

Form/Template
Mar 27, 2024

DML ES SAP

.PDF | 752.77 KB

Privacy impact assessment for DML-ES -SAP provides a fully integrated automated information system that supports medical logistics functionality including medical supply, equipment maintenance, and assemblage management.

Form/Template
Mar 27, 2024

8th MDG Kunsan AB_MEDCOI

.PDF | 735.62 KB

Privacy impact assessment for the 8th MDG Kunsan AB_MEDCOI enclave architecture consists of hardware, software, and telecommunications

Form/Template
Mar 27, 2024

DML ES Core

.PDF | 759.37 KB

Privacy impact assessment for DML-ES -Core provides a fully integrated automated information system that supports medical logistics functionality including medical supply, equipment maintenance, facility management, and assemblage management.

Form/Template
Mar 27, 2024

18th MDG Kadena AB MEDCOI

.PDF | 732.40 KB

Privacy impact assessment for the 18th MDG Kadena AB MEDCOI enclave architecture consists of hardware, software, and telecommunications.

Form/Template
Mar 27, 2024

374th MDG Yokota AB MEDCOI

.PDF | 742.17 KB

Privacy impact assessment for the 374th MDG Yokota Air Base MEDCOI enclave architecture consists of hardware, software, and telecommunications.

Form/Template
Mar 27, 2024

LRMC MedCOI

.PDF | 738.04 KB

Privacy impact assessment for the Landstuhl Regional Medical Center MedCOI enclave architecture consists of hardware, software, and telecommunications.

Form/Template
Mar 27, 2024

Munson Army Health Clinic AHC

.PDF | 729.53 KB

Privacy impact assessment for the Munson Army Health Clinic - Ft. Leavenworth MEDCOI enclave architecture consists of hardware, software, and telecommunications.

Form/Template
Mar 25, 2024

Assisted Reproductive Services for the Benefit of Seriously or Severely Ill/Injured (Category II or III) Active Duty Service Members: Qualifying Service Member Information and Attestation

.PDF | 2.64 MB

The DHA Form 407 as an attestation from the Service member of their intent to parent any child born as a result of the covered Assisted Reproductive Technology (ART) services they are seeking. It also serves to collect information that will allow the Managed Care Support Contractor to link a referral to Service members and any TRICARE-enrolled ...

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