• 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.

• 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.

• 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

• 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).