Quantcast Right Side of File Folder (cont) - Medical Records and Sick Call Procedures

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DA Form 3763, Community Health Nursing--Case Referral.
DA Form 5569-R, Isoniazid (INH) Clinic Flow Sheet.
State ambulance forms.
SF 602, HREC--Syphilis Record.
DA Form 199, Physical Evaluation Board Proceedings.
DA Form 2173, Statement of Medical Examination and Duty Status.
DA Form 3349, Physical Profile.
(10) DA Form 3947, Medical Evaluation Board Proceedings.
(11) DA Form 4060, Record of Optometric Examination (form is no longer
(12) DA Form 4530, Electroencephalogram Request and History.
(13) DA Form 4700, Medical Record--Supplemental Medical Data.
(14) DA Form 5008, Telephone Medical Advice Consultation Record.
(15) DA Form 5551-R, Spirometry Flow Sheet.
(16) SF 88, Report of Medical Examination (form must be included in all
HRECs; also file DA Forms 4497-R and FAA Forms 8500-8 with SF 88).
(17) SF 93, Report of Medical History (form must be included in all HRECs;
also file any other medical history forms with SF 93).
(18) SF 513, Medical Record--Consultation Sheet (also file DD Form 2161,
Referral for Civilian Medical Care, with SF 513).
(19) SF 522, Medical Record--Request for Administration of Anesthesia and
for Performance of Operations and Other Procedures.
(20) SF 559, Medical Record--Allergen Extract Prescription-New and Refill.
(21) DA Form 5007-R, Record of Hyposensitization.
(22) Other SF 500-series forms (file in numerical sequence).

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