Record of Occupational Exposure to Ionizing Radiation (DD Form 1141)
This form is initiated when military personnel are first exposed to ionizing radiation with the exception of patients incurring such radiation while undergoing diagnostic treatment. Thereafter, it becomes a permanent part of the member’s health record.
Instructions for preparing DD Form 1141 are on the back of the form. Further instruction concerning the applicability and use of the form and the source of necessary information are contained in the Radiation Health Protection Manual, NAVMED P-5055.
Individual Sick Slip (DD Form 689)
The purpose of this form (fig. 10-11) is to provide cross-medical service notification of a service member’s medical treatment between the medical services of the armed forces.
DD Form 689 may also be used to exchange information between the medical officer concerned and the unit commander within the naval establishment. When a member, following treatment, is unable to return to his or her organization either for duty or reporting purposes, use of the form does not preclude the immediate notification of a member’s unit commander by telephone or message. This form may be initiated for an individual who has requested or received medical treatment of a sick call nature. It serves as an interim document to furnish information from which subsequent entries are recorded in the health record. It is not prepared when direct cross-servicing of the health record is performed. DD Form 689 is not a record document and should be disposed of as soon as the information is transcribed to the SF 600 except where further use is indicated in connection with line-of-duty determination.
Preparation and use of this form is discussed in MANMED, chapter 16.
ADJUNCT HEALTH RECORD FORMS AND REPORTS
This section provides instruction for using certain forms in the health record in lieu of transcribing their data to the SF 600, Chronological Record of Medical Care.
Narrative Summary (SF 502)
The purpose of the SF 502 is to summarize pertinent clinical data relative to treatment received during periods of hospitalization. For all members (officer and enlisted), the original (typewritten) SF 502 is placed in the health record. For officer and enlisted members, entries concerning admissions to the sicklist, showing the nature of the disease, illness or injury, pertinent history or circumstances of occurrence, treatment rendered, and disposition, will be entered on the SF 502. Also indicate whether the disease or injury was or was not suffered in the line of duty and was or was not due to the member’s own misconduct.
Abbreviated Clinical Record (SF 539)
A copy of SF 539 may be filed in the health record when used for active-duty personnel in uncomplicated inpatient care of brief duration (less than 48 hours of hospitalization) and when SF 502 is not otherwise required. However, the information entered on SF 539 must be legible and provide adequate documentation concerning the origin, nature, conduct, status, and aggravation by service, if any, of the condition requiring hospitalization.
Consultation Sheet (SF 513)
When a report of consultation on an outpatient is recorded on SF 513, it maybe incorporated directly into the health record immediately behind the SF 600 or 88 that directs the consult. The SF 513 maybe used by dental officers requesting a medical consultation on a dental patient. The SF 513 is to be included in the member’s dental record.
If the SF 513 is illegible, transcribe the information to the SF 600. The results of all laboratory examinations performed in conjunction with the consultation are transcribed to the SF 513.
Medical Board Report (NAVMED 6100/1)
Whenever a member of the naval service is reported on by a medical board, a legible copy of the report shall be placed in the health record in lieu of transcribing the clinical data to the SF 600. A notation is also made on the current SF 600 to indicate that the clinical data is contained in the copy of the Medical Board Report incorporated in the health record. When the Medical
