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Refrigerator Temperature Log - Fahrenheit

Form/Template
3/25/2021

Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.

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Vaccine Storage and Handling

Steps to take for Potentially Compromised Vaccine Event

Form/Template
3/25/2021

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Refrigerator Temperature Log - Celsius

Form/Template
3/25/2021

Temperature log for refrigerators storing vaccines, with form for recording vaccine storage troubleshooting.

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Vaccine Storage and Handling

Freezer Temperature Log - Fahrenheit

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3/25/2021

Temperature log for freezers storing vaccines, with form for recording vaccine storage troubleshooting.

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Vaccine Storage and Handling

DHA Form 207: COVID-19 Vaccine Screening and Immunization Document, v19

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3/25/2021

The purpose of this form is to determine if the COVID-19 vaccine can be administered to the patient. (v19, April 2022)

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Emergency Vaccine Retrieval and Storage Plan Worksheet

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3/24/2021

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Sample WISDOM Agenda 5 Day

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2/11/2021

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aCME Disclosure FY20 Fillable

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1/29/2021

Instructor CME Disclosure form

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Research Repository Template

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1/20/2021

The RRT asks researchers whether they intend to put data into a repository, and if yes, what data and under what governance terms.

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Privacy and Civil Liberties

Data Sharing Agreement Application (DSAA)

Form/Template
1/12/2021

The Data Sharing Agreement Application (DSAA) is used when requesting data from systems that are owned and/or managed by DHA.

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EWSC Student Enrollment Form

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1/8/2021

Fillable student enrollment form for EWSC registration.

JOP Nomination Form

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11/24/2020

Student/nominee JOP course request form.

DHA Privacy Office Standard Contract Language

Form/Template
10/27/2020

This Section addresses the Contractor’s requirements under The Privacy Act of 1974 (Privacy Act), The Freedom of Information Act (FOIA), and The Health Insurance Privacy and Accountability Act (HIPAA) as set forth in applicable statutes, implementing regulations and DoD issuances.

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HIPAA Safeguard Review of Non-Federal Systems (HSR)

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10/1/2020

The HIPAA Safeguard Review of Non-Federal Systems (HSR) is used when data obtained through a DSAA will be stored, transmitted, processed, or otherwise maintained on a non-federal information system.

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Dental Common Access System

Form/Template
9/2/2020

Dental Common Access System (DENCAS)

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

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