Please take a moment to complete this short application.
Its function is strictly to assist us in providing information that best meets your interests
as they pertain to health care information privacy and security.
1. How are you affiliated with the Department of Defense?
2. If you are located at a Military Treatment Facility (MTF), please indicate your location. If you do not know the official MTF location, please see the MTF Locator as follows:
3. What is your role? Select all that apply:
Administrative Support Services
Ancillary Clinical -- All clinical ancillary personnel to include technicians
Business Finance Office- Resource Management, Personnel Staff and
Facility Support Services -- All non clinical support personnel
HIPAA Privacy Officer
HIPAA Security Officer
Information Management -IM/IT
Medical Records/Patient Administration - Patient Admin., Medical Records,
Codes and Transcriptions
Nursing - All clinical support personnel from Practitioner, Mid-Wife,
Anesthetists, Staff Nurses, and LPN
Privacy Act/FOIA Officer
Provider - Physicians, Phy. Asst., Dentist, and researchers
Senior Executive Staff - Executive leadership, Legal, Public Affairs and
4. E-mail Address: