(13) DA Form 5006-R, Medical Record--Authorization for Disclosure of
(14) DA Form 5303-R, Volunteer Agreement Affidavit.
(15) DA Form 3365, Authorization for Medical Warning Tag.
(16) Administrative documents and other correspondence.
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 OTRs; also file other basic chronological medical care records such as
SF 558 and AMOSIST Encounter Forms with SF 600).
State ambulance forms.
DA Form 5568-R, Chronological Record of Well-Baby Care.
DA Form 3763, Community Health Nursing--Case Referral.
DA Form 5569-R, Isoniazid (INH) Clinic Flow Sheet.
DA Form 4530, Electroencephalogram Request and History.
DA Form 4700, Medical Record--Supplemental Medical Data.
DA Form 5008, Telephone Medical Advice/Consultation Record.
(10) SF 513, Medical Record--Consultation Sheet (also file DD Form 2161,
Referral for Civilian Medical Care, with form).
(11) SF 522, Medical Record--Request for Administration of Anesthesia and
for Performance of Operations and Other Procedures.
(12) SF 559, Medical Record--Allergen Extract Prescription-New and Refill.
(13) DD Form 2482, Venom Extract Prescription.
(14) DA Form 5007-R, Record of Hyposensitization.
(15) Other SF 500-series forms (filed in numerical sequence).