(5)
SF 601, HREC--Immunization Record (form must be included in all
HRECs).
(6)
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
Information.
(16) DA Form 5303-R, Volunteer Agreement Affidavit.
(17) DA Form 3365, Authorization for Medical Warning Tag.
b. Right Side of File Folder.
(1)
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).
MD0920
2-5