CATEGORY TAPE box, according to the following
categories listed below:
Active duty military (This includes
reserves on active duty over 30 days)
Reserve military, not on active duty
DENTAL CLASSIFICATION TAPE
Color-coded dental classification tapes are no
longer used on the upper right-hand corner on the
inside back cover of the Dental Record Jacket.
IDENTIFICATION OF FORMS
It is imperative that all forms documenting patient
care contain adequate data to identify the patient and
permit filing of the forms in the dental record. All data
elements in the dental examination and treatment
forms should be completely filled out. All other forms
filed in the dental records should, at a minimum,
contain the following data in the identification block:
Patients FMP and sponsors SSN.
Patients name (last, first, middle initial).
Sponsors branch of service (e.g., Army, Navy,
or Air Force) and patients status (e.g., family
member or retired).
ARRANGEMENT OF FORMS
Prescribed forms will be filed in the dental record
in the following order. The forms will be arranged in
top to bottom sequence; like-numbered forms will be
grouped together with the most recent form placed on
top of each previous form, unless otherwise specified
INSIDE FRONT COVER OF DENTAL
Forms should be filed in the inside front cover of
the dental record jacket as follows:
1. Unmounted radiographs in envelopes.
2. Sequential bitewing radiograph.
3. Panographic or full-mouth radiographs.
Front of Dental Record Jacket Center Page
Forms should be filed in the front of the dental
record jacket center page as discussed in the following
(NAVMED 6600/3)Dental officers, civilian
dentists, and auxiliary personnel providing direct
patient care must ensure that each patient has a
completed, current Dental Health Questionnaire, in
his/her dental treatment record before performing an
examination or providing dental treatment.
NAVMED 6600/3 (fig. 2-10) must be filled out and
signed by each patient. This must be reviewed, dated,
and signed by the first dentist who conducts the
examination or dental treatment. For minors, i.e.,
under the age of consent or majority in the applicable
jurisdiction, the parent or guardian must fill out the
form and sign in the patients signature block of the
question, using his or her name and not the childs
Each dental care provider must indicate, in the
dental treatment section of the EZ603A that the
questionnaire has been reviewed and updated by the
patient. Dentist must also annotate on the EZ603 in the
O objective block, sections marked HQ dated,
Reviewed, and HQR Finding.
During annual dental exams, patients need only to
review, date, and sign the current questionnaire if
health status has not changed. Whenever a significant
change in medical history or health status occurs, a
new questionnaire must be filled out, dated, and
The initial and all later Dental Health Question-
naires are permanently maintained in the Dental
Treatment Record. For conditions that require medical
clarification, use the SF 513 (Consultation Sheet).
Document the consultation on the EZ603-Dental
Exam Form and in the Summary of Pertinent Findings
section of the NAVMED 6600/3. BUMED Instruction
6600.12 provides guidance for the Dental Health
BACK OF DENTAL RECORD JACKET
On this page of the dental record jacket, place all
Dental Exam Forms, EZ603s (Plan P side up) in
reverse chronological order.