SF 601, HREC--Immunization Record (form must be included in all
DA Form 4970, Medical Screening Summary--Over 40.
(7) DD Form 1141, Record of Occupational Exposure to Ionizing Radiation,
or Automated Dosimetry Record.
(8) SF 545, Laboratory Report Display (form must be included in all HRECs;
original copies of laboratory and radiographic reports, SF 546 through SF 557, are
mounted on this form).
(9) SF 519/519A, Medical Record--Radiographic Report (form must be
included in all HRECs).
(10) SF 519B, Radiologic Consultation Request/Report.
(11) SF 520, Clinical Record--Electrocardiographic Record (reports of
electrocardiograph examinations with representative tracings are attached to the back
of the form or on an attached sheet of paper).
(12) SF 560, Medical Record--Electroencephalogram Request and History.
(13) DA Form 2631-R, Medical Care--Third Party Liability Notification.
(14) DA Form 3647 or 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 3647/3647-1).
(15) DA Form 5006-R, Medical Record--Authorization for Disclosure of
(16) DA Form 5303-R, Volunteer Agreement Affidavit.
(17) DA Form 3365, Authorization for Medical Warning Tag.
b. Right Side of File Folder.
DA Form 4515, Personnel Reliability Program Record Identifier.
(2) SF 600, HREC--Chronological Record of Medical Care (form must be
included in all HRECs; also file other basic chronological medical care records such as
SF 558, DA Forms 5181-R, and AMOSIST Encounter Forms with SF 600s).