(23) DD Form 741, Eye Consultation.
(24) DD Form 771, Eyewear Prescription.
(25) DD Form 2215, Reference Audiogram.
(26) DD Form 2216, Hearing Conservation Data (also file supporting
documents with DD Form 2216).
(27) DA Form 4465, ADAPCP Client Intake Record with Privacy Act
Statement (also file authorized alcohol and drug forms with DA Form 4465).
(28) DA Form 4410-R, Disclosure Accounting Record (form must be included
if DA Form 3444-series folder is not used).
(29) DD Form 2005, Privacy Act Statement--Health Care Records (form
must be included if DA Form 3444-series folder is not used).
ACCESS TO HEALTH RECORDS
The personnel listed below may be authorized access to HRECs. All personnel
having access to HRECs or other medical records must protect the privacy of the
medical information contained in the records.
a. Medical Personnel. Army medical personnel are authorized direct access to
the contents of HRECs for purposes such as a diagnosis, treatment, and medical
b. Member to Whom the Health Record Pertains. Information from the HREC
or copies of the documents contained in the HREC may be furnished to the soldier.
c. Inspectors. Personnel engaged in inspections of MTF, dental activity, or
USAR records are authorized direct access to HRECs for the purpose of evaluating
compliance with regulations.
d. Graves Registration Personnel. Graves registration personnel are allowed
direct access to the HRECs of personnel killed in action or missing and can extract the
medical and dental information needed by their service.