b. Dental Health Record. The principal record maintained in a dental clinic is
the dental health record. This record consists of DA Form 3444, Treatment Record,
which is a folder used for the Dental Health Record; DA Form 5570, Health
Questionnaire for Dental Treatment; and SF 603, Health Record--Dental; and SF 603A,
Continuation of Health Record--Dental. See figures 2-3, 2-4, and 2-5. The Privacy Act
Statement is imprinted on the inside back cover of the folder (DD Form 3444). Entries
on the dental health record must be recorded in accordance with TB MED 250,
Recording Dental Examination, Diagnosis and Treatment, and Appointment Control.
The dental health record is a permanent document designed to furnish a
comprehensive dental history of each individual. It serves other purposes, such as
settling legal claims, supplying dental research data, and providing a means of
identifying deceased personnel when other methods are inadequate. All entries must
be accurate, complete, and concise if the best interest of the patient is to be served.
This record accompanies other personnel records when an individual is transferred to
Figure 2-3. DA Form 3444, Treatment Record