Medical Records
HCA Programs
ExMed Admin
Decedent Affairs
Forms
100

What is written if the patient does not have a middle name?

NMN

100

What is the Navy's policy on drug abuse?

Zero Tolerance

100

What is the reference number for the Manual of Medical Department?

NAVMED P-117

100

What is the PADD and what does it stand for?

PNOK and Person Authorized Direct Disposition

100

What is the SF 522

Request for Anesthesia

200

What are the three major categories of primary medical records?

*Health Records (HREC)

*Outpatient Records (OREC)

*Inpatient Records (IREC)

200

On what day will a Newborn be switched to TRICARE STANDARD if not enrolled in Prime?

61st

200

What admin tool is used to track medical and dental readiness of Navy and MC operational units?

Shipboard Non-Tactical Automatic Data Processing Automated Medical System (SAMS)

200

Which program can only be activated upon the enactment of special legislation?

Return of Remains Program

200

What is the SF 515

Tissue Examination

300

Which category of primary medical record documents ambulatory treatment?

Outpatient Record

300

The primary goal of what program is to help resolve patient complaints and problems through patient intervention and negotiations?

Patient Relations Program

300

What are the two basic types of directives?

permanent and temporary

300
When must a casualty report be submitted?

Within 4 hours after it is determined there is a casualty

300

What is the form number for an Eyewear Prescription?

DD 771
400

What is the form name of the US Navy Medical Outpatient and Dental Treatment Record?

NAVMED 6150/21-30

400

What is the form number for the Uniformed Services Identification and Privilege Card application?

DD 1172

400

What is the maximum amount of time notices can remain in effect?

1 year
400

During what hours will a PADD be notified of a death?

0500 and 2400

400

What is the DD 2005

Privacy Act Statement

500

What form is the NAVMED 6150/7

Health Record Receipt (Pink Card)

500

Who is the command's primary advisor for all alcohol and drug matters?

Drug and Alcohol Program Advisor (DAPA)

500

What is used to review and correct any IMR deficiencies?

Periodic Health Assesment

500

What are the dimensions of an oversized casket?

25 x 81 inches

63.5 cm x 2.06 m

500

What is the DD 2604

Certificate of Death