Because primary healthcare providers of active duty personnel must be aware of their crew's medical status at all times, temporary and ancillary records will not be opened or maintained for active duty personnel. The exceptions to this policy are records for obstetrics/gynecology (OB/GYN), family advocacy, and psychology and psychiatry clinical records.

The healthcare provider creating a secondary medical record should write a note stating the nature of the secondary record, the patient's diagnosis, and the clinic or department name, address, and telephone number on the NAVMED 6150/20, Summary of Care, of the patient's primary medical record. The healthcare provider should make a second note entry on the NAVMED 6150/20 when the secondary record is closed.

Convenience Record
A convenience record contains excerpts from a patient's primary record and is kept within the MTF by a treating clinic, service, department, or individual provider for increased access to the information. When the convenience record's purpose has been served, the establishing clinic, service, department, or provider purges the record from its file, compares it to the primary medical record, and adds any medical documents that are not already in the primary medical record.

Temporary Record
A temporary record is an original medical record established and retained in a specialty clinic, service, or department in addition to the patient's primary medical record. Its purpose is to document a current course of treatment. The temporary medical record becomes a part of the primary medical record when the course of treatment is concluded. This record is most commonly established in OB/GYN for a prenatal patient.

Ancillary Record
Ancillary records consist of original healthcare documentation withheld from a patient's primary HREC or OREC. In certain cases it may be advisable to not file original treatment information in the primary treatment record, but instead place this information into a secondary medical record, to which the patient, parent, or guardian has limited access. Examples of such instances include information that is potentially injurious to the patient, or information that requires extraordinary degrees of protection (such as psychiatric treatment or instances of real or suspected child or spouse abuse, etc).

THE MEDICAL RECORD

LEARNING OBJECTIVE: Recall custody guidelines for medical records.

All medical records are the property of the U.S. Government and must be maintained by MTFs (naval hospitals, medical clinics, and medical departments of ships, submarines, aviation squadrons, and isolated duty locations) that have primary cognizance over the care of the patient. Medical records are of continuing long-term interest to the government and the patient and must be maintained within an MTF. Patients may not retain original HRECs, ORECs, or dental records. Hand-carrying medical records by unauthorized individuals (e.g., spouses or siblings of the patient) without written permission is prohibited.

HEALTH RECORD CUSTODY
The HRECis retained in the custody of the medical officer on the ship, submarine, or aviation squadron to which the member is assigned. For those ships, submarines, and aviation squadrons that do not have medical officers, the health record may be placed in the custody of the medical department representative (MDR) at the discretion of the commanding officer (CO). Examples of MDRs are Independent Duty Corpsman or Squadron Corpsman. When Medical Department personnel are not assigned, the CO may assign custody of the health records to the local representatives of the Medical Department who generally furnish medical support. The custody of health record by an individual is not permitted.

Health records are subject to inspection at any time by the commanding officer, superiors in the chain of command, the fleet medical officer, or other authorized inspectors. The health record is for official use only, and adequate security and custodial care are required.

There are many methods of providing adequate security and custodial control of health records. In general, health records should be stored in such a manner as to be inaccessible to the crew or general public. No records or record pages should be left unattended. This precaution also helps to prevent loss or misplacement of records.

Medical Department personnel will maintain a Health Records Receipt, File Chargeout, and Disposition Record, NAVMED6150/7, for each health record in their custody. The completed charge out form should be retained in the file until the record is returned.

Medical officers or MDRs are responsible for the completeness of required health record entries while the record remains in their custody.

CROSS-SERVICING HEALTH RECORDS
The HREC of a Navy or Marine Corps member is normally serviced by personnel of the Medical Department of the Navy. However, if a Navy or Marine Corps member is performing an assignment with the Army or the Air Force, the health record may be serviced by Army or Air Force Medical Department personnel. This management of the health record may be done if the attendant service interposes no objection and considers the procedure feasible. Reciprocal procedures for servicing the health records of Army or Air Force personnel by personnel of the Medical Department of the Navy will be maintained whenever feasible, and if requested by authorized representatives of those services.