What are the three major categories of primary medical records?
1. Health records (HRECs)
2. Outpatient records (ORECs)
3. Inpatient records (IRECs)
What Record is a medical file the documents care provided to a patient assigned to a designated inpatient bed at a MTF or Ship?
Inpatient Record
Opening a secondary medical record requires the healthcare provider to write a note on the (what form)?
DD Form 2766
What is a DD Form 2766 called?
Adult Preventive and Chronic Care Flow Sheet
Secondary medical records include three records. What are they?
1. Convenience records
2. Temporary records
3. Ancillary records
What record is an original medical record established and retained in a specialty clinic, service, or department in addition to the patient's primary medical record?
Temporary Medical Record
All treatment records are the property of the (_______).
U.S. Government
(Who) has ultimate responsibility for all medical records?
The CO
The MTF having custody of the record at the time of acceptance of appointment will make necessary entries to indicate the new grade.
True or False
True
What is a DD 2807 and a DD 2808?
1.Report of Medical History
2.Report of Medical Examination
A (_____) or (____) pen will be used to record all identifying data, except in the "Pencil Entries" block.
Felt-tip and Permanent Black-Ink Pen
What is the Family Member Prefix for the Sponsor?
20
What is the Family Member Prefix for the Children?
01-19
(First Child 01, Second Child 02, etc.)
What is the Family Member Prefix for the Spouse?
30
(First Spouse 30, Second Spouse 31, etc)
What is the Family Member Prefix for the Mother, Stepmother?
40-44
What is the Family Member Prefix for the Father, Stepfather?
45-49
What is the Family Member Prefix for the Mother-in-law?
50-54
What is the Family Member Prefix for the Father-in-law?
55-59
What is the Family Member Prefix for the Other Authorized Dependents?
60-69
What is the Family Member Prefix for the Beneficiary Authorized by Statute?
90-95
What is the Family Member Prefix for the Civilian Emergencies?
98
What is the Family Member Prefix for All Others?
99
How would you indicate whether the record will be an Outpatient or Dental Treatment Record?
by attaching 1/2 inch red cellophane tape
Under the Terminal Digit Filing System, the central files are divide into (How many) approximately equal sections?
100
What are the Colors for Medical Records?
0-9
0. Orange
1. Green
2. Yellow
3. Grey
4. Tan
5. Blue
6. White
7.Almond
8. Pink
9. Red
What is the NAVMED 6150/7?
Health Record Receipt
What is NAVMED 6150? And where is it located?
Summary of care form (Always top form)
PART I (Inside front cover)
What is SF 601? And where is it located?
Immunization Record
PART I (Inside front cover)
What is NAVMED 6000/2? And where is it located?
Chronological record of HIV Testing
PART I (Inside front cover)
What is DD 2215? And where is it located?
Reference Audiogram
PART I (Inside front cover)
What is a DD 2216? And where is it located?
Hearing Conversation Data
PART I (Inside front cover)
What is a SF 600, HREC? And where is it Located?
Health Record- Chronological Record of Medical Care
Part II: Section A (Front of Center Page)
What is a SF 513? And where is it located?
Medical Record Consultation Sheet
Part II: Section A (Front of Center Page)
What is a DD 2604? And where is it Located?
Certificate of Death
Part II: Top Forms After a Patient is Deceased
What is a SF 502? And where is it located?
Narrative Summary
Part II: Section B: Inpatient Care Ambulatory Surgeries, etc.
What is a SF 509? And where is it Located?
Progress Notes
Part II: Section B: Inpatient Care Ambulatory Surgeries, etc.
What is a SF 600? And where is it located?
Chronological Record of Medical Care
Part II: Section B: Inpatient Care Ambulatory Surgeries, etc.
What is a SF 517? And where is it located?
Anesthesia
Part II: Section B: Inpatient Care Ambulatory Surgeries, etc.
What is a SF 522? Where is it located?
Request for Administration of Anesthesia
Part II: Section B: Inpatient Care Ambulatory Surgeries, etc.
What is NAVMED 1300/1? And where is it Located?
Medical and Dental Overseas Screening Review for Active Duty and Dependents
Part III (Back of Center Page)
What is NAVPERS 1300/16? And where is it located?
Report of Suitability for Overseas Assignment
Part III (Back of Center Page)
What is a SF 78? And where is it located?
Certificate of Medical Examination
Part III (Back of Center Page)
Where is DD 2807 and 2808 located?
Part III (Back of Center Page)
What is a DD 877? And where is it located?
Request for Medical/Dental RecordsPart III (Back of Center Page)