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Military Treatment Record Management > Military Treatment Forms > Flashcards

Military Treatment Forms Flashcards

1
Q

DD 2766

A

Adult Preventative and Chronic Care Flow Sheet

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2
Q

NAVMED 6230/4

A

Immunization Records

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3
Q

NAVMED 6000/2

A

Record of HIV Testing

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4
Q

NAVMED 6000/2

A

Record of HIV Testing

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5
Q

DD 771

A

Eyewear Prescription

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6
Q

NAVMED 6470/10

A

Record of Occupational Exposure to Ionizing Radiation

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7
Q

NAVMED 6470/11

A

Record of Exposure to Ionizing Radiation from Internally Deposited Radionuclides

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8
Q

DD 2215

A

Reference Audiogram

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9
Q

DD 2216

A

Hearing Conservation Data

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10
Q

NAVMED 6224/1

A

TB Contact/Reactor

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11
Q

NAVMED 6260/5

A

Asbestos Medical Surveillance Program

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12
Q

DD Form 2493-1

A

Asbestos Exposure Part 1, Initial Medical Questionnaire

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13
Q

DD 2493-2

A

Asbestos Exposure Part 2, Periodic Medical Questionnaire

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14
Q

OPNAV 5100/15

A

Medical Surveillance Questionnaire

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15
Q

Other 5100 Forms

A

Occupational Health Series Forms

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16
Q

NAVPERS 5510/1

A

Record Identifier for Personnel Reliability Program (PRP)

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16
Q

NAVPERS 5510/1

A

Record Identifier for Personnel Reliability Program (PRP)

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17
Q

SF 558

A

Medical Record-Emergency Care Treatment Record

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18
Q

NAVMED 1300/1

A

Medical, Dental, and Educational Suitability Screening for Service and Family Members

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18
Q

NAVMED 1300/1

A

Medical, Dental, and Educational Suitability Screening for Service and Family Members

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19
Q

NAVPERS 1300/16

A

Report of Suitability for Overseas Assignment Part 1,2,3

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20
Q

DD 2808

A

Report of Medical Examination

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21
Q

DD 2808

A

Report of Medical Examination

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22
Q

DD 2807-1

A

Report of Medical History

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23
Q

DD 2792

A

EFM Program Application

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24
Q

DD 2792

A

EFM Program Application

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25
Q

NAVMED 6100/1

A

Medical Board Report Cover Sheet

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26
Q

NAVMED 6100/2

A

Medical Board Statement of Patient

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27
Q

NAVMED 6100/3

A

Medical Board Certificate Relative to a PEB Hearing

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28
Q

NAVMED 6100/5

A

Abbreviated Temporary Limited Duty

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29
Q

SF 2842-C

A

Physicians Statement for Employee Disability Retirement

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30
Q

SF 47

A

Physical Fitness Inquiry for Motor Vehicle Operators

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31
Q

SF 78

A

Certificate of Medical Examination

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32
Q

NAVMED 6120/1

A

Competence of Duty Examination

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33
Q

NAVMED 6120/2

A

Officer Physical Examination Special Questionnaire

34
Q

NAVMED 6120/3

A

Annual Certificate of Physical Condition

35
Q

NAVMED 6150/2

A

Special Medical Duty Abstract

36
Q

NAVMED 6150/4

A

Abstract of Service and Medical History

37
Q

NAVJAG 5800/10

A

Injury Report

38
Q

SF 600

A

Chronological Record of Medical Care

39
Q

SF 513

A

Consultation Sheet

40
Q

DD 2161

A

Referral for Civilian Medical Care

41
Q

DD 2064

A

Certificate of Death

42
Q

SF 503

A

Autopsy Protocol

43
Q

SF 523

A

Authorization for Autopsy

44
Q

SF 523A

A

Disposition of Autopsy

45
Q

SF 523A

A

Authorization for Tissue Donation

46
Q

SF 523B

A

Authorization for Tissue Donation

47
Q

NAVMED 6300/5

A

Inpatient Admission/Disposition Record

48
Q

SF 502

A

Narrative Summary

49
Q

SF 539

A

Abbreviated Medical Record

50
Q

SF 509

A

Progress Note

51
Q

SF 516

A

Operation Report

52
Q

SF 600

A

Chronological Record of Medical Care

53
Q

SF 517

A

Anesthesia

54
Q

SF 522

A

Request for Administration of Anesthesia

55
Q

SF 533

A

Prenatal and Pregnancy

56
Q

DD 602

A

Patient Evacuation Tag

57
Q

DD 2005

A

Privacy Act Statement

58
Q

DD 2569

A

Third Party Collection Program

59
Q

DD 877

A

Request for Medical/Dental Records

60
Q

OPNAV 5211/9

A

Record of Disclosure

61
Q

SF 217

A

Medical Report Epilepsy

62
Q

SF 515

A

Tissue Examination

63
Q

SF 519A

A

Radiographic Report

64
Q

SF 519B

A

Medical Record- Radiographic Consultation Request/Report

65
Q

SF 518

A

Blood Transfusion

66
Q

SF 520

A

EKG Request

67
Q

SF 524

A

Radiation Therapy

68
Q

SF 525

A

Radiation Therapy Summary

69
Q

SF 526

A

Interstitial/ Intercavity Therapy

70
Q

SF 527

A

Group Muscle Strength, Joint ROM, Girth & Length Measurements

71
Q

SF 528

A

Muscle Function by Nerve Distribution:

Face, Neck, and Upper Extremity

72
Q

SF 529

A

Muscle Function by Nerve Distribution:

Trunk and Lower Extremity

73
Q

SF 530

A

Neurological Exam

74
Q

SF 531

A

Anatomical Figure

75
Q

SF 541

A

Gynecological Cytology

76
Q

SF 545

A

Laboratory Report Display

77
Q

SF 546

A

Laboratory Reports

78
Q

SF 559

A

Allergen Extract Prescription

79
Q

SF 580

A

Electroencephalogram Request & Hx

79
Q

SF 580

A

Electroencephalogram Request & Hx

80
Q

SF 511

A

Vital Signs Record

80
Q

SF 511

A

Vital Signs Record

81
Q

SF 512

A

Plotting Chart

82
Q

SF 512A

A

Plotting Chart Blood Pressure

Military Treatment Record Management (11 decks)

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