b. PHS Form 731. A copy of PHS Form 731 is sent with the Health Record for
later entries of immunization data. This form is clipped or fastened to SF 601 until after
initial immunizations are given. It is not punched like permanent documents in the
record. The name and SSN of the person is typed or written in ink on the front of PHS
Form 731. The address put on the PHS 731 for officers and warrant officers is HQDA
(DAPC-POR-R), Alexandria, VA 22332; the address for enlisted personnel is
Commander, U.S. Army Enlisted Records and Evaluation Center, Fort Benjamin
Harrison, IN 46249. The name of the person's unit is entered below the double line at
the bottom of the form, but will not be entered until he reaches his first training or duty
c. Responsibilities. The unit commander is responsible for ensuring that each
assigned or attached member receives the immunizations required by AR 40-562. A
check of the immunization status of each unit member will be made periodically. The
unit commander, in consultation with the local medical officer, will ensure that
immunizations are given when due.
2-11. OTHER REQUIRED FORMS PREPARED FOR THE HREC
Four additional forms are initiated when a member enters the service for
inclusion in the HREC.
a. SF 88, Report of Medical Examination. The identification data is entered
on this form. This data includes name, home address, grade and component, SSN,
sex, race, date and place of birth, name and address of next-of-kin, and rating. The
SF 88 is completed by a medical officer in accordance with AR 40-501. The original of
each of these forms is filed in the HREC. See figure 2-5.
b. SF 93, Report of Medical History. The identification data is entered on this
form also. This data includes name , SSN, home address, grade, and component.
Items 8 through 24 are usually completed by the service member. Item 25 of the SF 93
is completed by a medical officer in accordance with AR 40-501 with the original of each
of these forms in the HREC. See figure 2-6.
c. SF 545 (Laboratory Report Display). Initially, only the name and social
security number are entered as identification data on this form; later, the patient's
recording card is used to imprint additional data such as organization address and
telephone number. As laboratory tests are completed, the forms with the results are
attached to SF 545. See figure 2-7.
d. DA Form 5571 (Master Problem List). This form will be filed in each health
record to provide a summary of significant past surgical procedures, past and current
diagnoses of problems, and currently or recently used medications. See figure 2-8.