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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 two 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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Offsite Clinic Vaccine Inventory Issue Return Receipt and Temp Log Celsius

Form/Template
8/12/2019

When transporting vaccine off-site, you must log their storage temperature every hour to ensure they are kept at the required temperature range for the duration of the event.

Recommended Content:

Vaccine Storage and Handling

Offsite Clinic FROZEN Vaccine Inventory Issue Return Receipt and Temp Log Celsius

Form/Template
8/12/2019

When transporting vaccine off-site, you must log their storage temperature every hour to ensure they are kept at the required temperature range for the duration of the event.

Recommended Content:

Vaccine Storage and Handling

Steps to take for Potentially Compromised Vaccine Event

Form/Template
8/12/2019

Recommended Content:

Vaccine Storage and Handling | Potential Vaccine Compromise Reporting

Storage Unit Sticker Template

Form/Template
8/12/2019

Some resources you can use to protect your vaccine storage unit and warn staff to not turn off power to the unit.

Recommended Content:

Vaccine Storage and Handling

Emergency Vaccine Retrieval and Storage Plan Worksheet

Form/Template
8/12/2019

Recommended Content:

Vaccine Storage and Handling | Potential Vaccine Compromise Reporting

Freezer Temperature Log - Fahrenheit

Form/Template
8/12/2019

Temperature log for freezers storing vaccines.

Recommended Content:

Vaccine Storage and Handling

Freezer Temperature Log - Celsius

Form/Template
8/12/2019

Temperature log for freezers storing vaccines.

Recommended Content:

Vaccine Storage and Handling

Refrigerator Temperature Log - Fahrenheit

Form/Template
8/12/2019

Monitoring the temperature of your vaccine storage unit is required at least twice a day, and should be logged using this form.

Recommended Content:

Vaccine Storage and Handling

Refrigerator Temperature Log - Celsius

Form/Template
8/12/2019

Temperature log for refrigerators storing vaccines.

Recommended Content:

Vaccine Storage and Handling

Theater Medical Information Program-Joint Composite Health Care System Caché (TC2).

Form/Template
8/5/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Theater Medical Information Program-Joint Composite Health Care System Caché (TC2).

Defense Occupational and Environmental Health Readiness System - Industrial Hygiene (DOEHRS-IH)

Form/Template
7/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Occupational and Environmental Health Readiness System - Industrial Hygiene (DOEHRS-IH) system.

Air Force Medical Omnibus Web Applications (AFMOWAP)

Form/Template
7/22/2019

This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Air Force Medical Omnibus Web Applications (AFMOWAP)

Unsolicited Additional Discount Program Agreement

Form/Template
7/15/2019

TRICARE Retail Refund Program Unsolicited Additional Discount Program Bid. To be completed and submitted for new Unsolicited ADP Bids.

Pediatric and Adult Influenza Screening and Immunization Documentation

Form/Template
6/1/2019

A form for screening both children and adults for contraindications to receiving influenza vaccine for the 2019-2020 season.

Recommended Content:

Influenza Seasonal

AFRSSIR Supply Order Request

Form/Template
5/22/2019

Fill out this request to place and order with the Armed Forces Repository of Specimen Sample for the Identification of Human Remains

Recommended Content:

Armed Forces Repository of Specimen Samples for the Identification of Remains (AFRSSIR) | Specimen Collection Supplies Ordering Instructions | Armed Forces Medical Examiner System
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DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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