Military Treatment Forms Flashcards

(86 cards)

1
Q

DD 2766

A

Adult Preventative and Chronic Care Flow Sheet

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2
Q

NAVMED 6230/4

A

Immunization Records

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3
Q

NAVMED 6000/2

A

Record of HIV Testing

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4
Q

NAVMED 6000/2

A

Record of HIV Testing

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5
Q

DD 771

A

Eyewear Prescription

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6
Q

NAVMED 6470/10

A

Record of Occupational Exposure to Ionizing Radiation

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7
Q

NAVMED 6470/11

A

Record of Exposure to Ionizing Radiation from Internally Deposited Radionuclides

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8
Q

DD 2215

A

Reference Audiogram

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9
Q

DD 2216

A

Hearing Conservation Data

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10
Q

NAVMED 6224/1

A

TB Contact/Reactor

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11
Q

NAVMED 6260/5

A

Asbestos Medical Surveillance Program

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12
Q

DD Form 2493-1

A

Asbestos Exposure Part 1, Initial Medical Questionnaire

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13
Q

DD 2493-2

A

Asbestos Exposure Part 2, Periodic Medical Questionnaire

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14
Q

OPNAV 5100/15

A

Medical Surveillance Questionnaire

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15
Q

Other 5100 Forms

A

Occupational Health Series Forms

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16
Q

NAVPERS 5510/1

A

Record Identifier for Personnel Reliability Program (PRP)

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16
Q

NAVPERS 5510/1

A

Record Identifier for Personnel Reliability Program (PRP)

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17
Q

SF 558

A

Medical Record-Emergency Care Treatment Record

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18
Q

NAVMED 1300/1

A

Medical, Dental, and Educational Suitability Screening for Service and Family Members

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18
Q

NAVMED 1300/1

A

Medical, Dental, and Educational Suitability Screening for Service and Family Members

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19
Q

NAVPERS 1300/16

A

Report of Suitability for Overseas Assignment Part 1,2,3

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20
Q

DD 2808

A

Report of Medical Examination

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21
Q

DD 2808

A

Report of Medical Examination

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22
Q

DD 2807-1

A

Report of Medical History

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23
DD 2792
EFM Program Application
24
DD 2792
EFM Program Application
25
NAVMED 6100/1
Medical Board Report Cover Sheet
26
NAVMED 6100/2
Medical Board Statement of Patient
27
NAVMED 6100/3
Medical Board Certificate Relative to a PEB Hearing
28
NAVMED 6100/5
Abbreviated Temporary Limited Duty
29
SF 2842-C
Physicians Statement for Employee Disability Retirement
30
SF 47
Physical Fitness Inquiry for Motor Vehicle Operators
31
SF 78
Certificate of Medical Examination
32
NAVMED 6120/1
Competence of Duty Examination
33
NAVMED 6120/2
Officer Physical Examination Special Questionnaire
34
NAVMED 6120/3
Annual Certificate of Physical Condition
35
NAVMED 6150/2
Special Medical Duty Abstract
36
NAVMED 6150/4
Abstract of Service and Medical History
37
NAVJAG 5800/10
Injury Report
38
SF 600
Chronological Record of Medical Care
39
SF 513
Consultation Sheet
40
DD 2161
Referral for Civilian Medical Care
41
DD 2064
Certificate of Death
42
SF 503
Autopsy Protocol
43
SF 523
Authorization for Autopsy
44
SF 523A
Disposition of Autopsy
45
SF 523A
Authorization for Tissue Donation
46
SF 523B
Authorization for Tissue Donation
47
NAVMED 6300/5
Inpatient Admission/Disposition Record
48
SF 502
Narrative Summary
49
SF 539
Abbreviated Medical Record
50
SF 509
Progress Note
51
SF 516
Operation Report
52
SF 600
Chronological Record of Medical Care
53
SF 517
Anesthesia
54
SF 522
Request for Administration of Anesthesia
55
SF 533
Prenatal and Pregnancy
56
DD 602
Patient Evacuation Tag
57
DD 2005
Privacy Act Statement
58
DD 2569
Third Party Collection Program
59
DD 877
Request for Medical/Dental Records
60
OPNAV 5211/9
Record of Disclosure
61
SF 217
Medical Report Epilepsy
62
SF 515
Tissue Examination
63
SF 519A
Radiographic Report
64
SF 519B
Medical Record- Radiographic Consultation Request/Report
65
SF 518
Blood Transfusion
66
SF 520
EKG Request
67
SF 524
Radiation Therapy
68
SF 525
Radiation Therapy Summary
69
SF 526
Interstitial/ Intercavity Therapy
70
SF 527
Group Muscle Strength, Joint ROM, Girth & Length Measurements
71
SF 528
Muscle Function by Nerve Distribution: | Face, Neck, and Upper Extremity
72
SF 529
Muscle Function by Nerve Distribution: | Trunk and Lower Extremity
73
SF 530
Neurological Exam
74
SF 531
Anatomical Figure
75
SF 541
Gynecological Cytology
76
SF 545
Laboratory Report Display
77
SF 546
Laboratory Reports
78
SF 559
Allergen Extract Prescription
79
SF 580
Electroencephalogram Request & Hx
79
SF 580
Electroencephalogram Request & Hx
80
SF 511
Vital Signs Record
80
SF 511
Vital Signs Record
81
SF 512
Plotting Chart
82
SF 512A
Plotting Chart Blood Pressure