2-12. CONTENTS OF OUTPATIENT TREATMENT RECORDS
The basic form contained in the OTR is the SF 600, HREC--Chronological
Record of Medical Care. The SF 600 is completed in the same general manner as
given in paragraph 2-10. Forms are filed in the OTR in the following order (top to
bottom). If more than one of the same form is present, they are filed in chronological
order with the most recent form first. Additional information concerning the OTR can be
found in AR 40-66, Medical Record and Quality Assurance Administration. Most OTRs
will not have all of the listed forms.
a. Left Side of File Folder.
DA Form 4186, Medical Recommendation for Flying Duty.
DA Form 3180/3180A, Personnel Screening and Evaluation Record.
Pediatric growth charts from civilian sources.
DA Form 5571, Master Problem List.
DA Form 5510-R, Exceptional Family Member Program Coding
SF 601, HREC--Immunization Record (form must be included in all
(7) SF 545, Laboratory Report Display (form must be included in all OTRs;
original copies of laboratory and radiographic reports, SF 546 through SF 557, are
mounted on the form).
(8) SF 519/519A, Medical Record--Radiographic Report (form must be
included in all OTRs).
SF 519B, Radiologic Consultation Request/Report.
(10) SF 520, Clinical Record--Electrocardiographic Record (reports of
electrocardiograph examinations with representative tracings are attached to the back
of the form or to an attached sheet of paper).
(11) SF 560, Medical Record--Electroencephalogram Request and History.
(12) DA Form 3647/3647-1, Inpatient Treatment Record Cover Sheet (copies
of SF 502, SG Form 84, AF Form 565, NAVMED 6300.5, DD Form 1380, and/or other
narrative summaries pertaining to the hospitalization are filed with the appropriate DA
Form 3647 or 3647-1).