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Freezer Temperature Log - Celsius

Form/Template
3/25/2021

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

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Vaccine Storage and Handling

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

DHA Form 207: COVID-19 Vaccine Screening and Immunization Document, v23

Form/Template
3/25/2021

The purpose of this form is to determine if the COVID-19 vaccine can be administered to the patient. (v23, Oct. 2022)

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Coronavirus & the MHS Response | COVID-19 Vaccine Efforts | Coronavirus and the COVID-19 Vaccine | COVID-19 Information for Military Treatment Facility Directors

Emergency Vaccine Retrieval and Storage Plan Worksheet

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3/24/2021

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Vaccine Storage and Handling | Potential Vaccine Compromise Reporting

Sample WISDOM Agenda 5 Day

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2/11/2021

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M2 Functional Specifications | MDR, M2, ICDs Functional Support

aCME Disclosure FY20 Fillable

Form/Template
1/29/2021

Instructor CME Disclosure form

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Defense Medical Readiness Training Institute | DMRTI Course Information | Emergency War Surgery Course (EWSC)

Research Repository Template

Form/Template
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 & Civil Liberties

EWSC Student Enrollment Form

Form/Template
1/8/2021

Fillable student enrollment form for EWSC registration.

JOP Nomination Form

Form/Template
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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Privacy & Civil Liberties | Privacy Contract Language

HIPAA Safeguard Review of Non-Federal Systems (HSR)

Form/Template
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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Data Sharing Agreements

Dental Common Access System

Form/Template
9/2/2020

Dental Common Access System (DENCAS)

MDR Special Justification Form

Form/Template
4/1/2020

Military Health System Data Repository (MDR) Special Justification Form. MDR Users will use this to request access to special tables in the MDR.

DD Form 3110: Routine Immunization Screening Form: Pediatric

Form/Template
3/11/2020

A screening checklist for contraindications to vaccines for children and teens.

DD Form 3111: Routine Immunization Screening Form: Adults

Form/Template
3/11/2020

A screening checklist for contraindications to vaccines for adults.

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Last Updated: July 20, 2022
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