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UNIT 4 Forms Flashcards

1
Q

LEFT SIDE- PART 1

A

Summary of care RECORD OF PREVENTIVE MEDICINE AND OCCUPATIONAL HEALTH

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2
Q

DD 2766

A

ADULT PREVENTIVE AND CHRONIC CARE FLOW SHEET

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3
Q

NAVMED 6230/4

A

IMMUNIZATION RECORD

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4
Q

NAVMED 6000/2

A

CHRONOLOGICAL RECORD OF HIV TESTING

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5
Q

DD 771

A

EYE WEAR PRESCRIPTION

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6
Q

DD 2215

A

REFERENCE AUDIOGRAM

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7
Q

DD2016

A

HEARING CONSERVATION DATA

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8
Q

NAVMED 6224/1

A

TB CONTACT/ REACTOR

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9
Q

NAVMED 6260/5

A

ASBESTOS MEDICAL SURVEILLANCE PROGRAM

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10
Q

DD 2493-1

A

ASBESTOS EXPOSURE- PART I, INITIAL MEDICAL QUESTIONNAIRE

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11
Q

DD 2493-2

A

ASBESTOS EXPOSURE -PART II, PERIODIC MEDICAL QUESTIONAIRE

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12
Q

OPNAV 5100/15

A

MEDICAL SURVEILANCE QUESTIONAIRE

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13
Q

OTHER 5100 FORMS

A

OCCUPATIONAL HEALTH SERIES FORMS

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14
Q

RIGHT SIDE- PART 2 SECTION A

A

RECORD OF MEDICAL CARE AND TREATMENT

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15
Q

NAVPERS 5510/1

A

RECORD IDENTIFIER FOR PERSONNEL RELIABILITY PROGRAM (PRP)

ALWAYS TOP FORM EXCEPT FOR DEATHS

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16
Q

SF558

A

MEDICAL RECORD -EMERGENCY CARE AND TREATMENT RECORD

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17
Q

SF 600

A

CHRONOLOGICAL RECORD OF MEDICAL CARE

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18
Q

SF 513

A

CONSULTATION SHEET

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19
Q

DD 2161

A

REFERRAL FOR CIVILIAN MEDICAL CARE

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20
Q

DD 2064

A

CERTIFICATE OF DEATH

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21
Q

SF 503

A

AUTOPSY PROTOCOL

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22
Q

SF 523

A

AUTHORIZATION FOR AUTOPSY

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23
Q

SF 523A

A

DISPOSITION OF DEATH

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24
Q

SF 523B

A

AUTHORIZATION FOR TISSUE DONATION

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25
Q

RIGHT SIDE PART 2 SECTION B

A

INPATIENT CARE, AMBULATORY SURGERIES, ETC…

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26
Q

NAVMED 6300/5

A

INPATIENT ADMISSION/ DISPOSITION RECORD (COPY)

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27
Q

SF 502

A

NARRATIVE SUMMARY (COPY)

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28
Q

SF 539

A

ABBREVIATED MEDICAL RECORD (COPY)

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29
Q

SF 509

A

PROGRESS NOTES

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30
Q

SF 516

A

OPERATION REPORT

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31
Q

SF 600

A

CHRONOLOGICAL RECORD OF MEDICAL CARE

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32
Q

SF 517

A

ANESTHESIA

33
Q

SF 522

A

REQUEST FOR ADMINISTRATION OF ANESTHESIA

34
Q

SF 533

A

PRENATAL AND PREGNANCY

35
Q

DD 602

A

PATIENT EVACUATION TAG

36
Q

DD 2005

A

PRIVACY ACT STATEMENT

37
Q

LEFT SIDE PART 3

A

PHYSICAL QUALIZICATIONS, ADMINISTRATIVE FORMS

38
Q

NAVPERS 1300/16

A

Report of SUITABILITY FOR OVERAEAS ASSIGNMENTS

39
Q

NAVMED 6100/1

A

MEDICAL BOARD REPORT COVER SHEET

40
Q

NAVMED 6100/2

A

MEDICAL BOARD STATEMENT OF PATIENT

41
Q

NAVMED 6100/3

A

MEDICAL BOARD CERTIFICATE RELATIVE TO A PEB HEARING

42
Q

NAVMED 6100/5

A

ABBREVIATED TEMPORARY LIMITED DUTY

43
Q

SF 2842-C

A

PHYSICIANS STATEMENT FOR EMPLOYEE DISABILITY RETIREMENT

44
Q

SF 47

A

PHYSICAL FITNESS INQUIRY FOR MOTOR VEHICLE OPERATIONS

45
Q

SF 78

A

CERTIFICATE OF MEDICAL EXAMINATION

46
Q

DD 2808

A

REPORT OF MEDICAL EXAMINATION

47
Q

DD 2807-1

A

REPORT OF MEDICL HISTORY

48
Q

NAVMED 6120/1

A

COMPETENCE OF DUTY EXAMINATION

49
Q

NAVMED 6120/2

A

OFFICER PHYSICAL EXAMINATION SPECIAL QUESTIONNAIRE

50
Q

NAVMED 6120/3

A

ANNUAL CERTIFICATE OF PHYSICAL CONDITION

51
Q

NAVMED 6150/2

A

SPECIAL DUTY MEDICAL ABSTRACT

52
Q

NAVMED 6150/4

A

ABSTRACT OF SERVICE AND MEDICAL HISTORY

53
Q

NAVJAG 5800/10

A

INJURY REPORT

54
Q

DD 2792

A

EXCEPTIONAL FAMILY MEMBER PROGRAM

55
Q

DD 2569

A

THIRD PART COLLECTION PROGRAM

56
Q

DD 877

A

REQUEST FOR MED/DENT RECORDS

57
Q

RIGHT SIDE- PART 4

A

RECORD OF ANCILLARY STUDIES, THERAPIES, ETC…

58
Q

SF 217

A

MEDICAL REPORT- EPILEPSY

59
Q

SF 515

A

TISSUE EXAMINATION

60
Q

SF 519A

A

RADIOGRAPHIC REPORT

61
Q

SF 519B

A

MEDICAL RECORD- RADIOGRAPHIC CONSULTATION REQUEST/REPORT

62
Q

SF 518

A

BLOOD OR BLOOD COMPONENT TRANSFUSION

63
Q

SF520

A

ELECTROCARDIOGRAM REQUEST

64
Q

SF 524

A

RADIATION THERAPY

65
Q

SF 525

A

RADIATION THERAPY SUMMARY

66
Q

SF 526

A

INTERSTITUAL/ INTERCAVITY THERAPY

67
Q

SF 527

A

GROUP MUSCLE STRENGTH, JOINT ROM, GIRTH AND LENGTH MEASUREMENTS

68
Q

SF 528

A

MUSCLE FUNCTION BY NERVE DISTRIBUTION: FACE, NECK AND UPPER EXTREMITY

69
Q

SF 529

A

MUSCLE FUNCTION BY NERVE DISTRIBUTION: TRUNK AND LOWER EXTREMITY

70
Q

SF 530

A

NEUROLOGICAL EXAMINATION

71
Q

SF 531

A

ANATOMICAL FIGURE

72
Q

SF 541

A

GYNECOLOGIC CYTOLOGY

73
Q

SF 545

A

LABORATORY REPORT DISPLAY

74
Q

SF546-557

A

LABORATORY REPORTS

75
Q

SF 559

A

ALLERGEN EXTRACT PRESCRIPTION

76
Q

SF 580

A

ELECTROENCEPHALOGRAM REQUEST AND HISTORY

77
Q

SF 511

A

VITAL SIGNS REPORT

78
Q

SF 512

A

PLOTTING CHART

79
Q

SF 512A

A

PLOTTING CHART- BLOOD PRESSURE

SF IDC (39 decks)

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