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1/5/2023
This template shall be used to renew an executed Data Sharing Agreement (DSA) that incorporates an approved Data Sharing Agreement Application (DSAA). Submit this completed request or questions to the DHA Privacy and Civil Liberties Office (Privacy Office) at dha.ncr.j-6.mbx.dsa-mail@health.mil.
Form/Template
1/3/2023
Use this form to obtain records/reports/photos of remains by persons legally authorized access to this information.
Form/Template
12/2/2022
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.
Form/Template
12/2/2022
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.
Form/Template
11/15/2022
Privacy Impact Assessment for AHLTA, a fully integrated health care information system used in Department of Defense Military Treatment Facilities and clinics.
Form/Template
11/10/2022
Pentax endoPRO iQ is a video and imaging application and the primary function is the maintenance/storage of patient and procedure data.
Form/Template
11/7/2022
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).
Form/Template
10/24/2022
TRICARE Dispute Resolution Form for manufacturers. For use on resubmitted rejected disputes.
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10/24/2022
340b Verification Form to be completed by the manufacturer and pharmacy for any 340b claim disputes.
Form/Template
10/5/2022
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.
Form/Template
10/1/2022
Temperature log for freezers storing vaccines, with form for recording vaccine storage troubleshooting.
Form/Template
10/1/2022
Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.
Form/Template
10/1/2022
Temperature log for freezers storing vaccines, with form for recording vaccine storage troubleshooting.
Form/Template
10/1/2022
Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.
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Last Updated: October 22, 2021