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Military Health System

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AFMES Form 7: AFDIL Casework Request

Form/Template
5/23/2023

Armed Forces Medical Examiner System form 7 - Armed Forces DNA Identification Laboratory Casework Request.

AFMES Form 44: DFT Client Feedback Survey

Form/Template
5/23/2023

AFMES Form 44 Division of Forensic Toxicology Client Feedback Survey.

AFMES Form 42-R: Evidence Chain of Custody

Form/Template
5/23/2023

Armed Forces Medical Examiner System Form 42-R, Evidence Chain of Custody.

72ND MDG TINKER AFB MEDCOI 508 COMPLIANT

Form/Template
5/17/2023

Privacy Impact Assessment, 72nd Medical Group (MDG) Tinker Air Force Base (AFB) Medical Community of Interest (MEDCOI).

CIS MIL Enclave PIA

Form/Template
5/17/2023

Privacy Impact Assessment, Clinical Information System (CIS) -.mil Enclave.

81st MDG Keesler AFB MEDCOI

Form/Template
5/17/2023

Privacy Impact Assessment, 81st Medical Group (MDG) Keesler Air Force Base (AFB) Medical Community of Interest (MEDCOI).

66th MDG Hanscom AFB MEDCOI

Form/Template
5/17/2023

Privacy Impact Assessment 66th MDG Hanscom AFB MEDCOI.

Automated Information Discovery Environment Medical Common Operating Picture (AIDE MedCOP)

Form/Template
5/17/2023

Privacy Impact Assessment, Automated Information Discovery Environment Medical Common Operating Picture (AIDE MedCOP).

DRAEGER INFINITY DELTA SERIES

Form/Template
5/17/2023

Privacy Impact Assessment, Draeger Infinity Delta Series AI.

AFHSD 501 Request Form

Form/Template
5/2/2023

Armed Forces Health Surveillance Division (AFHSD) Epidemiology and Analysis AFHSD 501 Request Form

TRICARE Retail Refund NDC Transfer Form

Form/Template
1/25/2023

Use this form to transfer Products or NDCs between Manufacturer Labelers, for billing purposes, in the TRICARE Retail Refund Program.

DHA DSA Modification Request - Data Sharing Agreements

Form/Template
1/13/2023

This template shall be used to modify an executed Data Sharing Agreement (DSA) that incorporates an approved Data Sharing Agreement Application (DSAA).

DSA Extension Request - Data Sharing Agreements

Form/Template
1/13/2023

This template shall be used to request a 30 day extension in order to continue to use the data in accordance to the executed Data Sharing Agreement (DSA).

DHA DSAA Prerequisite Checklist - Data Sharing Agreements

Form/Template
1/13/2023

This checklist is designed to ensure you have completed the Data Sharing Agreement Application (DSAA) pre-submission reviews and have the necessary documentation to submit a DSAA. You must complete and submit this Prerequisite Checklist (PRC) to the Defense Health Agency (DHA) Privacy and Civil Liberties Office (PCLO) before you submit a DSAA or it will be declined.

DHA DSA Application - Data Sharing Agreement

Form/Template
1/5/2023

This template is used to assist the Defense Health Agency (DHA) Privacy and Civil Liberties Office (Privacy Office) with its consideration of prospective data uses involving DHA data.

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Last Updated: September 13, 2022
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