AGFA NX Family of Systems (CR/DR) vNX27_A&I
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 five 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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Recent Forms & Templates
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Popular Forms & Templates
Neurobehavioral Symptom Inventory Form
DHA-GL Worksheet 02: Pre-Authorization Request
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Medical Readiness Decision Support System (MRDSS)
Patient Global Impression Change Scale
MHS Service Help Desk
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MHS GENESIS Electronic Health Record
Limited Duty Sailor and Marine Readiness Tracker MHS Application Access Gateways
We found 635 items
Form/Template
July 29, 2014
Patient Safety Reporting (PSR)
.PDF |
87.41 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Patient Safety Reporting (PSR) system.
Form/Template
July 29, 2014
Active Directory Domain Services (AD DS)
.PDF |
74.39 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Active Directory Domain Services (AD DS) system.
Form/Template
July 29, 2014
Pharmacy Data Transaction Service (PDTS)
.PDF |
80.17 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Pharmacy Data Transaction Service (PDTS) system.
Form/Template
July 29, 2014
Nutrition Management Information System (NMIS)
.PDF |
85.07 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Nutrition Management Information System (NMIS) system.
Form/Template
July 29, 2014
Health Net Federal Services Information System (HNFS IS)
.PDF |
74.37 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Health Net Federal Services Information System (HNFS IS) system.
Form/Template
July 29, 2014
Humana Military Healthcare Services Automated Information System (HMHS AIS)
.PDF |
71.90 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Humana Military Healthcare Services Automated Information System (HMHS AIS) system.
Form/Template
July 29, 2014
Clinical Information System (CIS)/Essentris ©
.PDF |
69.66 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Clinical Information System (CIS)/Essentris © system.
Form/Template
July 29, 2014
Delta Dental Federal Government Programs Information System (DDFGP-IS)
.PDF |
76.81 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Delta Dental Federal Government Programs Information System (DDFGP-IS) system.
Form/Template
July 29, 2014
Defense Medical Human Resources System - Internet (DMHRSi)
.PDF |
83.96 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Defense Medical Human Resources System - Internet (DMHRSi) system.
Form/Template
July 29, 2014
Designated Provider Health Care Delivery System (DPHCDS)
.PDF |
80.86 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the Designated Provider Health Care Delivery System (DPHCDS) system.
Form/Template
July 29, 2014
United Concordia Companies Inc. (UCCI) Active Duty Dental Program (ADDP)
.PDF |
99.80 KB
This Military Health System (MHS) Privacy Impact Assessment (PIA) summarizes the United Concordia Companies Inc. (UCCI) Active Duty Dental Program (ADDP) system.
Form/Template
June 6, 2014
Plan of Action and Milestone Template
.PDF |
163.93 KB
This template is used to track plans of action and milestones regarding potential breaches.
Form/Template
June 1, 2014
Cosmetic Surgery Superbill 2014
.PDF |
292.24 KB
Use this form to bill for cosmetic surgery.
Form/Template
June 1, 2014
Formal Appeal Request
.PDF |
263.60 KB
Defense Health Agency - Great Lakes Worksheet (DHA-GL Worksheet-03) Complete this form when submitting a formal appeal for denied medical claims or denied pre-authorization requests by the DHA, Great Lakes.
Form/Template
April 30, 2014
Data Request Template (DRT) - Access by Login (all DHA Systems)
.XLSM |
25.81 KB
The Data Request Template for Access by Login for all DHA Systems is required for a Data Sharing Agreement Application.
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