TAB C - Selected Medical Record Forms

SF 88 ........................................................................................................Report of Medical Examination

SF 502 ............................................................................................Narrative Summary (Clinical Resume)

SF 513 .........................................................................................................................Consultation Sheet

SF 539 .........................................................................................................Abbreviated Medical Record

AF 560 ..........................................................................................Authorization and Treatment Statement

SF 600 ..........................................................................................Chronological Record of Medical Care

SF 601 .....................................................................................................................Immunization Record

HSC 621-R (Test) ............................................................................................Individual Medical History

PHS 731 .......................................................................................International Certificates of Vaccination

DD 771 ....................................................................................................................Eyewear Prescription

AF 1480 ........................................................................................................................Summary of Care

AF 1480A ..........................................................................Adult Preventive and Chronic Care Flowsheet

DD 2766 .............................................................................Adult Preventive and Chronic Care Flowsheet

DA 3647 .....................................................................................Inpatient Treatment Record Cover Sheet

DA 8007 ..........................................................................................................Individual Medical History

Deployment Health Assessments

Initial ..........................................................Pre-Deployment Health Assessment (April 1997)

..................................................................Post-Deployment Health Assessment (April 1997)

Revised ......................................................Pre-Deployment Health Assessment (April 1997)

..................................................................Post-Deployment Health Assessment (April 1997)

Current ..............................................Pre-Deployment Health Assessment (September 1998)

..........................................................Post-Deployment Health Assessment (September1998)

Botulinum Toxoid Vaccine Information Sheet


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