<p>General Medical Officer (GMO) Manual: Administrative Section Pertinent Medical Forms Department of the Navy Bureau of Medicine and Surgery Peer Review Status: Internally Peer Reviewed </p><p>(1) The following forms are available per CD ROM NAVSUP PUB 600 (NLL): (a) Department of Defense (DD) forms</p><p> DD 214 (11-88), Certificate of Release or Discharge from Active Duty, S/N 0102-LF-006- 5500.</p><p> DD 1172 (8-87), Application for Uniformed Services Identification and Privilege Card DEERS Enrollment, S/N 0102-LF-001-1723.</p><p> DD 1251 (4C) (7-91), Uniformed Services Medical Treatment Facility Non Availability Statement, S/N 0102-LF-012-3700.</p><p> 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.</p><p> DD 2161 (10-78), Referral for Civilian Medical Care, S/N 0102-LF-002-1611.</p><p> DD 2493-1 (3-87), Asbestos Exposure Initial Medical Questionnaire - Part 1, S/N 0102-LF- 002-4935.</p><p> DD 2493-2 (3-87), Asbestos Exposure Initial Medical Questionnaire - Part 2, S/N 0102-LF- 002-4940.</p><p> DD 2697 (2-95), Report of Medical Assessment. Used in conjunction with physical examination.</p><p>(b) Bureau of Medicine and Surgery (NAVMED) forms</p><p> NAVMED 6100/5 (10-89), Abbreviated Limited Duty Medical Board Report, S/N 0105-LF- 2800.</p><p> NAVMED 6120/1 (1-82), Competence for Duty Examination, S/N 0105-LF-206-1206.</p><p> NAVMED 6150/2 (4-70), Special Duty Medical Abstract, S/N 0105- 209-5021.</p><p> 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.)</p><p> NAVMED 6260/5 (5-90), Periodic Health Evaluation, Navy Asbestos Medical Surveillance Program, History and Physical Examination, S/N 0105-LF-009-9800.</p><p> NAVMED 6260/7 (5-90), Periodic Health Evaluation, Navy Asbestos Medical Surveillance Program, Roentgenographic Interpretation for Pneumoconiosis, S/N 0105-LF-009-9900.</p><p> NAVMED 6410/1 (6-78), Grounding Notice (Aero Medical), S/N 0105-LF-206-4105.</p><p>(c) Chief of Naval Operations (OPNAV) forms  OPNAV 5100/15 (5-90), Medical Surveillance Questionnaire, S/N 0107-LF-010-1400</p><p> OPNAV 1 650/3, Personal Award Recommendation (1-94), S/N 0107-LF-017-5800</p><p>(d) Navy Comptroller (NAVCOMPT) form </p><p> NAVCOMPT 3065 (2-83), Leave Request/Authorization, S/N 0104-LF-703-0656</p><p>(e) Bureau of Naval Personnel (NAVPERS) forms</p><p> NAVPERS 1000/22 (11-81), Acceptance and Oath of Office, S/N 0106-LF-010-0851</p><p> NAVPERS 1 070/66 (8-82), Officer Service Record, Navy, S/N 0106- LF-017-1662</p><p> 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</p><p> NAVPERS 1 070/602 (7-72), Dependency Application/Record of Emergency, S/N 0106-LF- 018-6035</p><p> NAYPERS 1210/5 (9-75), Classification Officer Qualifications Questionnaire, S/N 0106-LF- 012-1025</p><p> NAVPERS 1 301/1 (10-83), Officer Preference and Personal Information Card, S/N 0106- LF-013-0109</p><p> NAVPERS 1336/3 (9-75), Special Request/Authorization, S/N 0106- LF-063-8633 (2) 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.</p><p> SF 523 (10-75), Authorization for Autopsy, NSN 7540-00-634-4166.</p><p> SF 600 (6-97), Chronological Record of Medical Care, NSN 7540-00-634-4176. (3) The following form is available from the Bureau of Naval Personnel:</p><p> NAVPERS 1301/51, Officer Data Card. (Rev. 6-95).</p><p>Reviewed by LCDR Robert A. Rahal, MSC, USN, Assistant Specialty Leader for Patient Administration, Bureau of Medicine and Surgery, Washington, D.C. (1999). </p>