the Radiation Health Protection Manual, NAVMED
ADJUNCT HEALTH RECORD FORMS AND
This section provides instruction for using certain
forms in the health record instead of transcribing their
data to the SF 600, Chronological Record of Medical
Narrative Summary (SF 502)
The purpose of the SF 502 is to summarize clinical
data relative to treatment received during periods of
The narrative summary should
include all procedures and diagnoses, and must agree
w i t h i n f o r m a t i o n l i s t e d o n t h e
I n p a t i e n t
Admission/Disposition Report (NAVMED 6300/5)
and any information listed in the operation report.
The SF 502 should include the following
Reason for hospitalization, including a brief
clinical statement of the chief complaint and
history of the present illness.
All significant findings.
All procedures performed and treatment given,
including patients response, complications, and
The condition and relevant diagnosis at the time
of patients transfer or discharge.
Discharge instructions given to patients or their
families (i.e., physical activity permitted,
medication, diet, and follow-up care).
List of principal providers or attending
physicians and their signatures.
A completed copy of the SF 502 should
accompany patients who are transferred to another
medical facility. Upon discharge from the hospital, a
copy of the SF 502 should be taken to the members
parent command. The SF 502 informs the command of
any limitations, medications, and follow-up care the
service member may need. After command use, the
SF 502 should be placed into the members HREC. For
more detailed instruction on the use of the SF 502, refer
to the MANMED.
Abbreviated Clinical Record (SF 539)
The SF 539 may be used as a substitute for the
narrative summary for those admissions of a minor
n a t u r e t h a t r e q u i r e l e s s t h a n 4 8 h o u r s o f
hospitalization. A copy of SF 539 should be filed in the
Consultation Sheet (SF 513)
The SF 513 is used for outpatients who need to be
referred to other healthcare providers or specialists,
such as gynecologists, internists, optometrists, etc.
The primary patient assessment should be entered onto
the form. Include as well the results of examinations
and tests on the SF 513. The patient remains the
responsibility of the referring provider until the
specialist takes over the care.
In some cases, the
specialist will perform an examination or procedure
and refer the patient back to the original provider for
continued care. The original consultation form stays in
Medical Board Report (NAVMED 6100/1)
Whenever a member of the naval service is
reported on by a medical board, place a legible copy of
the report in the health record instead of transcribing
the clinical data to the SF 600. Make a notation on the
current SF 600 to indicate the clinical data is contained
in the copy of the Medical Board Report incorporated
in the health record, when the Medical Board Report is
forwarded to the Navy Department for review and
Enter a report of the
departmental action on the current SF 600.
Eyewear Prescription (DD Form 771)
T h e p u r p o s e o f D D f o r m 7 7 1 , E y e w e a r
Prescription (fig. 12-8), is to order corrective
prescription eyewear. Depending on its edition date
(any of which is authorized), the DD form 771 may
consist of a 3-copy carbon form (for use with pen), a
2-part carbonless form (printed on a tractor-feed
printer) (fig. 12-8A), or a computer-generated form
using virtual copies (fig. 12-8B). The original of the
form will be sent to the optical laboratory, and a copy of
the form will be placed in the patients HREC. As with
other standard forms, the DD 771 is frequently
submitted via computer modem or fax, depending on
Three major areas covered by the DD Form 771 are
patient information, prescription information, and