Dont Screw Up My Disability Flashcards
What provisions determine the standards for handling health records?
HIPAA, Privacy Act of 1974, FOIA
What form is the Health Record Receipt?
NAVMED 6150-7
When completing the DD-2808 what are the appropriate entries for Not Evaluated, Not Indicated and Not Applicable?
NE (items 17-42), NI, NA
Who endorses item 44 on the 2808?
Approving Official
Form number for Medical Board Report Cover Sheet?
CG-5684
This form provides a current, concise and comprehensive record of a member’s medical history.
SF-600
What form number is the International Certificate of Vaccine?
PHS-731 or CDC-731
What is the CG-5214?
Emergency Medical Treatment Report
Who receives Parts I, II and III of the CG-5214
Part I - Copy to patient record
Part II - Copy to Receiving Unit
Part III - Copy to Triage Officer (Mass Cas Incidents)
This form shall be used whenever an individual receives emergency treatment which cannot be documented in the electronic health record SF-600
SF-558 Emergency Care and Treatment
This form provides a multiple copy record of all emergency medical care rendered by CG personnel outside of a clinic or sickbay
CG-5214 Emergency Medical Treatment Report
This is the Eyewear Prescription Form?
DD-771
This form is prepared and inserted in the health record for each person for whom a confirmed diagnosis of syphilis or any of its complications or sequela has been established
Serology Record SF-602
Patients sign this form prior to administration of anesthesia
Request for Administration of Anesthesia and Performance of Operations and Other Procedures OF-522
When is the OF-522 not required?
Routine dental anesthesia (Ch 4)
What is form CG-4057
Chronological Record of Service
When is the CG-4057 used?
1 - As a statement of agreement or disagreement with the assumption of fitness for duty upon separation from the CG
2 - To terminate the health record
3 - Notification of benefits
What is form DD-2870
Authorization for Disclosure of Medical or Dental Information
What is DD-2871?
Request to Restrict Medical or Dental Information (used between units/clinics, MTFs)
What is the NAVMED 6600-3?
Dental Health Questionnaire
What is the SF-603?
Dental Record
What is the SF-603A
Dental Continuation
Guidance for the safe keeping of records is contained in what manual?
CIM 5260.2 USCG Freedom of information Act and Privacy Acts Manual
What is the email address for reporting inpatient status?
HQS DG HSWL Inpatient Hospitalization
How long are IMRs kept on file?
Retained at the creating health care facility for six years after the date the patient is released from overnight care. Then forward to NPRC
How long is a master list of IMRs forwarded to NPRC kept on file?
50 years
Active Duty episodic visits or routine appointment will be recorded on what form for Mental Health?
SF-600
