Medical Records

Front 1

U.S. Navy
Medical Outpatient and Dental Treatment
Record

Back 1

NAVMED 6150/21-30

Front 2

Guidelines for record management

Back 2

Manual of the Medical
Department (MANMED P-117)

Front 3

The three major categories of primary
medical records are

Back 3

* Health records (HRECs)
* Outpatient records (ORECs)
* Inpatient records (IRECs)
** Dental records (DRECs) are part of
HRECs (active duty) and ORECs (retirees
and family members)

Front 4

EZ603A

Back 4

Dental Treatment Form

Front 5

DD 2005

Back 5

Privacy Act Statement

Front 6

who has ultimate responsability for all medical records

Back 6

CO

Front 7

DD 2807

Back 7

Report of Medical
History

Front 8

DD 2808

Back 8

Report of Medical
Examination

Front 9

personel discharged before 31
January 1994

Back 9

requests should be sent to the
National Personnel Records Center (NPRC) for
record retrieval

Front 10

For service members who were
discharged after 31 January 1994

Back 10

requests for
record retrieval are sent to the Department of
Veterans Affairs (VA)

Front 11

A felt-tip or permanent black-ink pen will be
used to record all identifying data, except

Back 11

in the
"Pencil Entries" block on the upper left of the
outer front cover

Front 12

NAVMED 6150/29 as

Back 12

treatment record jacket for members who do not have an
SSN (e.g., foreign military personnel)

Front 13

Family Member Prefix

Back 13

Sponsor 20
Children 01-19
(First Child 01, Second
Child 02, etc.)
Spouse 30
(First Spouse 30,
Second Spouse 31, etc.)
Mother, Stepmother 40-44
Father, Stepfather 45-49
Mother-in-law 50-54
Father-in-law 55-59
Other Authorized
Dependents
60-69
Beneficiary Authorized
by Statute
90-95
Civilian Emergencies 98
All Others 99

Front 14

Identify flag officers and general officers medicla records by

Back 14

stamping or printing “FLAG OFFICER” or
"GENERAL OFFICER," as appropriate, on the
lower portion of the patient identification box

Front 15

CHCS

Back 15

Composite
Health Care System

Front 16

Part I (Inside Front Cover)

Back 16

*Date of arrival
• Projected rotation date
• Home address and telephone number
• Command UIC and telephone number

Front 17

Part II (Front of Center Page)

Back 17

DD 2005, PRIVACY ACT
STATEMENT

Front 18

Part III (Back of Center Page)

Back 18

Disclosure and release of information will be
covered later in this chapter

Front 19

IV (Inside Back Cover)

Back 19

The Forensic Examination form is
preprinted and located on the inside back cover
of the record jacket, and should be completed if
the record is going to be used for dental care

Front 20

Orange

Back 20

0

Front 21

Green

Back 21

1

Front 22

Yellow

Back 22

2

Front 23

Grey

Back 23

3

Front 24

Tan

Back 24

4

Front 25

Blue

Back 25

5

Front 26

white

Back 26

6

Front 27

Almond

Back 27

7

Front 28

Pink

Back 28

8

Front 29

Red

Back 29

9

Front 30

NAVMED 6150/7

Back 30

Health
Record Receipt also known as the pink

Front 31

NAVMED 6150

Back 31

summary of care form
(always top form