Forms for Medical History

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					Military Health
    Record

       NAVMED 6150
1. SERVICE & STATUS                 7. CENTER STAGE; PRIVACY ACT STATEMENT
2. PENCIL ENTRIES                        (FRONT); DISCLOSURE RECORD(BACK)
3. PLACE BLACK TAPE ON LAST DIGIT
       OF SSN                       8. BACK PAGE; PLACE BLACK TAPE ON LAST
4. PATIENT’S FAMILY MEMBER PREFIX        DIGIT OF SSN, FORENSIC EXAMINATION
5. SPONSOR’S SSN                         (FRONT
6. PATIENT’S FULL NAME              9. ALERT BOX
             The Purpose
   To provide an
    individual
    chronological record of
    medical treatment
    afforded members of
    naval service.
 The     health record of a military
     member may be used for the
     following:
1.   To aid in determining claims
2.   To determine physical fitness
3.   To provide data for medical statistics
    Health Records are color coded
according to the secondary number – the
second to last digit of the social security
                number.


  o   0’s – Orange    o   5’s – Blue
  o   1’s – Green     o   6’s – White
  o   2’s – Yellow    o   7’s – Almond
  o   3’s – Gray      o   8’s – Pink
  o   4’s – Tan       o   9’s - Red
   An individual’s medical record shall never remain their
    possession.
   Health records are for official use only but can be inspected at
    any time by: the commanding officer; authorized medical
    inspectors or the fleet medical officer.
   An individual’s medical record can be released to his authorized
    representative only when adequate proof of his death is provided
    and when the individual has been declared mentally incompetent.
   The Medical record is the property of the U.S. Government and
    must be maintained by the MTF of DTF which has primary
    cognizance over the care of the patient
   After 1994, a members medical & dental records were sent to
    Department of Veteran Affairs
           4 parts to Health Record
   Part 1 – Record of Preventive Medicine &
    Occupational Health
          Immunizations, Hearing, Visual ect.
   Part 2 – Record of Medical Care & Treatment
   Part 3 – Physical Qualifications
   Part 4 – Record of Ancillary Studies, Inpatient
    Care & Miscellaneous forms
          Privacy Act Statement, Report of Medical Examination,
           Report of Medical History
        Forms, Oh glorious forms
                 PART 1
   DD 771, Eyewear Prescription
   NAVMED 6470/10, Record of Occupational Exposure to
    Ionizing Radiation
   NAVMED 6470/11, Record of Exposure to Ionizing Radiation
   DD2215, Reference Audiogram
   DD2216, Hearing Conservation Data
   NAVMED 6224/1, TB Contact/Converter Follow-up
   NAVMED 6260/5, Asbestos Medical Surveillance Program
                                  More
            Part 2
   SF 600, Chronological Record of Medical Care
   DD 2064, Certificate of Death
   SF 502, Medical Record, Narrative Summary
           Part 3
   DD 2005, Privacy Act Statement
           Part 4
   SF 88, Report of Medical Examination
   SF 93, Report of Medical History
   NAVMED 6120/1, Competence for Duty Examination
   NAVMED 6150/2, Special Duty Medical Abstract
   NAVMED 6150/4, Abstract of Service & Medical History
   SF518, Medical Record – Blood or Blood Component
    Transfusion
   SF 545, Laboratory Report Display
          Closing Health Records
   Death or declared death
   Discharge
   Resignation
   Release from active duty
   Retirement
   Transfer to the Fleet Reserve or release to inactive duty
   Missing or missing in action
   Desertion
   Disenrollment as an officer candidate or midshipman
                  Retirement
   When placed on the retired list or Fleet Reserve
    List, close the record as you would a discharge.
   A new record (OREC) is given in it’s place; a
    copy will suffice.
   Make an entry on an SF 600 in the old record
    and in the new one stating the date the old
    record was closed.
                More forms
   NAVMED 6320/18- binnacle list
   NAVMED 6320/19- Morning report of the sick
   PHS 731- Int’l cert of vaccination
   SF 539- abbreviated clinical record
   SF 513- consultation sheet
   SF 601- Immunization record

				
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