has become commonplace. However, the NavyMedical Department continues to use manygovernment printed forms (e.g., NAVMED, DD, andSF). This section will cover selected (government-printed) medical forms, their purpose, and proceduresfor completing them.Healthcare providers should enter their signatureand identification data in the HREC in black orblue-black ink. Type, print, or stamp provider’s name,grade or rating, and social security number below theirsignature. Stamped facsimile signatures are NOT to beused on any medical form in the HREC. The signingindividual assumes responsibility for the correctnessof the entry for which they sign.All medical forms require an accurate andcomplete documentation of patient identification data.Patient identification data on medical documentationis critical. Complete and accurate documentation ofpatient identification data helps to ensure thedocuments are placed in the correct patient’s record.Three methods are currently used to place patientidentification on medical documents:embossed medical card,automated forms, andhandwritten entries.Embossed medical cards are used to imprintpatient identification data on medical forms. Printoutsof automated (computerized) forms should provide theinformation listed in table 12-1. Handwritten patientidentification data should be entered in spaces at thebottom of the form. Each method should contain, at aminimum, the patient identification data listed in table12-2.SUMMARY OF CARE (NAVMED 6150/20)The Summary of Care (fig. 12-3) contains asummation of relevant problems and medications thatsignificantly affect the patient’s health status. Properlymaintained, the Summary of Care form aids healthcareproviders by allowing them quick access to pertinentmedical factors that may affect how they manage apatient’s medical care. This form is a permanent partof the HREC.Entries on the NAVMED 6150/20 should includesignificant medical and surgical conditions, allergies,untoward reactions to medication, and medicationscurrently using or recently used. The Summary ofCare form should be reviewed, and, if necessary,revised during the patient’s visit. The NAVMED6150/20 should also be reviewed during yearlyverification and before HREC transfers.The Summary of Care form is divided into fivesections: significant health problems, hospitalization/surgery, medical alert, medications, and healthmaintenance.Significant health problems section: Enteronly significant medical conditions in this section.Significant medical conditions include chronic diseases(such as hypertension, diabetes, arthritis, etc.) and acuterecurrent illnesses (such as recurrent urinary tractinfections, recurrent otitis media, recurrent bronchitis,etc.)Hospitalization/surgery section: Entersignificant surgical conditions. Include all proceduresrequiring general or regional anesthesia and anyprocedures likely to have a long-term effect on thepatient’s health status.Medical alert section: Note any allergies andsignificant reactions to drugs in the medical alertsection. Record also in this section relevant alcohol andtobacco use.Medications section: Record all currently orrecently used medications.Medical maintenance section: This section ofthe NAVMED 6150/20 contains a variety of medicalinformation. It contains health maintenance functions,such as mammograms, chest X-rays, EKGs, and papsmears. Enter the date of the health maintenancefunctions in pencil, so it can be updated. Include in thissection occupational health surveillance activities, such12-11Item # Patient Identification Data1 Full name (last, first, middle)2 FMP + SSN3 Date of birth (YY-MM-DD)4 Sex of patient (M or F)5 Sponsor (self)6 Sponsor’s Agency or military service(USN, USMC, USCG,...)7 Patient’s paygrade (e.g., E7, O2)8 MTF maintaining record (e.g., NHPensacola, etc.)Table 12-2.—Patient Identification Data
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