RIGHT SIDE OF FOLDER (Continued)
Form Number
Form Title and Notes
DD Form 741
Eye Consultation.
DD Form 771
Eyewear Prescription.
Reports or certificates prepared by neuropsychiatric
consultation services.
Correspondence on hearing aids.
Medical documents from civilian sources.
*DA Form 4410-R
Disclosure Accounting Record (to be included when
preprinted DA Form 3444-series folders are not used).
*DD Form 2005
Privacy Act Statement--Health Care Records (to be
included when preprinted DA Form 3444-seri es folders
are not used).
*This form must be included in all OTRs.
Table 3-1. Forms and documents of the medical OTR (concluded).
Section II. INITIATING, KEEPING, USING, AND DISPOSING OF
OUTPATIENT TREATMENT RECORDS (OTRs)
3-4. INITIATING AND USING OTRs
An OTR is prepared by the first MTF a person reports to for outpatient treatment
and is continued as one record. Each contact with the AMEDD as an outpatient is
recorded in the OTR and it is kept by the MTF providing primary care. One copy of DA
Form 3647 and SF 502 are filed in the OTR following each period of hospitalization. If a
patient is taking part in research as a human subject, participation and treatment are
recorded in the OTR.
a. Preparation and Use of SF 600. SF 600 (Health Record - Chronological
Record of Medical Care) is the basic record of outpatient visits. Preparation of the SF
600 was covered in lesson 2.
MD0751
3-5