m. Listed below are the items that are completed on the DA Form 3444-Series.
You will find examples of completed DA Form 3444 following this list. Please note the
differences between the use of the forms as an HREC, and an OTR, specifically items 6
and 12. (See figures 1-14 and 1-15.)
Item 1 -
Select the correct color folder according to the
Item 2 -
"Patient Identification" block.
Item 3 -
Item 4 -
Code last digit of SSN.
Item 5 -
FMP, tertiary group and secondary group of SSN.
Item 6 -
Retirement "R" block (OTR and ITR).
Item 7 -
Status "S" block.
Item 8 -
"Type of Record" block.
Item 9 -
"Note to Physician" block (when applicable).
Item 10 -
Privacy Act (inside of folder).
Item 11 -
Special category (when applicable).
Item 12 -
Blood type (HREC only).
Item 13 -
Unit of patient (HREC only).