has become commonplace.
However, the Navy
Medical Department continues to use many
government printed forms (e.g., NAVMED, DD, and
SF). This section will cover selected (government-
printed) medical forms, their purpose, and procedures
for completing them.
Healthcare providers should enter their signature
and identification data in the HREC in black or
blue-black ink. Type, print, or stamp providers name,
grade or rating, and social security number below their
signature. Stamped facsimile signatures are NOT to be
used on any medical form in the HREC. The signing
individual assumes responsibility for the correctness
of the entry for which they sign.
All medical forms require an accurate and
complete documentation of patient identification data.
Patient identification data on medical documentation
is critical. Complete and accurate documentation of
patient identification data helps to ensure the
documents are placed in the correct patients record.
Three methods are currently used to place patient
identification on medical documents:
embossed medical card,
automated forms, and
Embossed medical cards are used to imprint
patient identification data on medical forms. Printouts
of automated (computerized) forms should provide the
information listed in table 12-1. Handwritten patient
identification data should be entered in spaces at the
bottom of the form. Each method should contain, at a
minimum, the patient identification data listed in table
SUMMARY OF CARE (NAVMED 6150/20)
The Summary of Care (fig. 12-3) contains a
summation of relevant problems and medications that
significantly affect the patients health status. Properly
maintained, the Summary of Care form aids healthcare
providers by allowing them quick access to pertinent
medical factors that may affect how they manage a
patients medical care. This form is a permanent part
of the HREC.
Entries on the NAVMED 6150/20 should include
significant medical and surgical conditions, allergies,
untoward reactions to medication, and medications
currently using or recently used. The Summary of
Care form should be reviewed, and, if necessary,
revised during the patients visit.
6150/20 should also be reviewed during yearly
verification and before HREC transfers.
The Summary of Care form is divided into five
sections: significant health problems, hospitalization/
surgery, medical alert, medications, and health
Significant health problems section: Enter
only significant medical conditions in this section.
Significant medical conditions include chronic diseases
(such as hypertension, diabetes, arthritis, etc.) and acute
recurrent illnesses (such as recurrent urinary tract
infections, recurrent otitis media, recurrent bronchitis,
Hospitalization/surgery section: Enter
significant surgical conditions. Include all procedures
requiring general or regional anesthesia and any
procedures likely to have a long-term effect on the
patients health status.
Medical alert section: Note any allergies and
significant reactions to drugs in the medical alert
section. Record also in this section relevant alcohol and
Medications section: Record all currently or
recently used medications.
Medical maintenance section: This section of
the NAVMED 6150/20 contains a variety of medical
information. It contains health maintenance functions,
such as mammograms, chest X-rays, EKGs, and pap
Enter the date of the health maintenance
functions in pencil, so it can be updated. Include in this
section occupational health surveillance activities, such
Patient Identification Data
Full name (last, first, middle)
FMP + SSN
Date of birth (YY-MM-DD)
Sex of patient (M or F)
Sponsors Agency or military service
(USN, USMC, USCG,...)
Patients paygrade (e.g., E7, O2)
MTF maintaining record (e.g., NH
Table 12-2.Patient Identification Data