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Operational Medicine 2001
GMO Manual

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General Medical Officer (GMO) Manual: Administrative Section

Pertinent Medical Forms

Department of the Navy
Bureau of Medicine and Surgery

The following forms are available per CD ROM NAVSUP PUB 600 (NLL):

Department of Defense (DD) forms

  • DD 214 (11-88), Certificate of Release or Discharge from Active Duty, S/N 0102-LF-006-5500.

  • DD 1172 (8-87), Application for Uniformed Services Identification and Privilege Card DEERS Enrollment, S/N 0102-LF-001-1723.

  • DD 1251 (4C) (7-91), Uniformed Services Medical Treatment Facility Non Availability Statement, S/N 0102-LF-012-3700.

  • DD 1 1934 (7-74), Geneva Convention Card for Medical and Religious Personnel Who Serve In or Accompany the Armed Forces, S/N 0102-LF-005-8700.

  • DD 2161 (10-78), Referral for Civilian Medical Care, S/N 0102-LF-002-1611.

  • DD 2493-1 (3-87), Asbestos Exposure Initial Medical Questionnaire - Part 1, S/N 0102-LF-002-4935.

  • DD 2493-2 (3-87), Asbestos Exposure Initial Medical Questionnaire - Part 2, S/N 0102-LF-002-4940.

  • DD 2697 (2-95), Report of Medical Assessment. Used in conjunction with physical examination.

Bureau of Medicine and Surgery (NAVMED) forms

  • NAVMED 6100/5 (10-89), Abbreviated Limited Duty Medical Board Report, S/N 0105-LF-2800.

  • NAVMED 6120/1 (1-82), Competence for Duty Examination, S/N 0105-LF-206-1206.

  • NAVMED 6150/2 (4-70), Special Duty Medical Abstract, S/N 0105- 209-5021.

  • NAVMED 6150/20 (1-94), Summary of Care, S/N 0105-LF-017-9000. (Replaced by) DD 2766 (3-98) Adult Preventive and Chronic Care Flowsheet, (S/N number not available yet, should be have soon.)

  • NAVMED 6260/5 (5-90), Periodic Health Evaluation, Navy Asbestos Medical Surveillance Program, History and Physical Examination, S/N 0105-LF-009-9800.

  • NAVMED 6260/7 (5-90), Periodic Health Evaluation, Navy Asbestos Medical Surveillance Program, Roentgenographic Interpretation for Pneumoconiosis, S/N 0105-LF-009-9900.

  • NAVMED 6410/1 (6-78), Grounding Notice (Aero Medical), S/N 0105-LF-206-4105.

Chief of Naval Operations (OPNAV) forms

  • OPNAV 5100/15 (5-90), Medical Surveillance Questionnaire, S/N 0107-LF-010-1400

  • OPNAV 1 650/3, Personal Award Recommendation (1-94), S/N 0107-LF-017-5800

Navy Comptroller (NAVCOMPT) form

  • NAVCOMPT 3065 (2-83), Leave Request/Authorization, S/N 0104-LF-703-0656

Bureau of Naval Personnel (NAVPERS) forms

  • NAVPERS 1000/22 (11-81), Acceptance and Oath of Office, S/N 0106-LF-010-0851

  • NAVPERS 1 070/66 (8-82), Officer Service Record, Navy, S/N 0106- LF-017-1662

  • NAVPERS 1070/74 (9-75), Officer's Report of Home of Record and Place from which Ordered to a Tour of Active Duty, S/N 0106-LF-010-7320

  • NAVPERS 1 070/602 (7-72), Dependency Application/Record of Emergency, S/N 0106-LF-018-6035

  • NAYPERS 1210/5 (9-75), Classification Officer Qualifications Questionnaire, S/N 0106-LF-012-1025

  • NAVPERS 1 301/1 (10-83), Officer Preference and Personal Information Card, S/N 0106-LF-013-0109

  • NAVPERS 1336/3 (9-75), Special Request/Authorization, S/N 0106- LF-063-8633

The following forms are available from the Federal Supply System through normal supply procurement procedures:

  • SF 513 (4-98), Medical Record Consultation Sheet NSN 7540-00-634-4127.

  • SF 523 (10-75), Authorization for Autopsy, NSN 7540-00-634-4166.

  • SF 600 (6-97), Chronological Record of Medical Care, NSN 7540-00-634-4176.

The following form is available from the Bureau of Naval Personnel:

  • NAVPERS 1301/51, Officer Data Card. (Rev. 6-95).

Reviewed by LCDR Robert A. Rahal, MSC, USN, Assistant Specialty Leader for Patient Administration, Bureau of Medicine and Surgery, Washington, D.C. (1999).

 

 

Approved for public release; Distribution is unlimited.

The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. 

Operational Medicine 2001

Health Care in Military Settings

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001

 United States Special Operations Command
7701 Tampa Point Blvd.
MacDill AFB, Florida
33621-5323

This web version is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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