When a HREC is lost or destroyed, the HREC custodian will open a replacement health record. The designation "REPLACEMENT" will be prominently entered on the jacket and all forms replaced. A brief explanation of the circumstances requiring the replacement and the date accomplished should be entered on SF 600, Chronological Record of Medical Care. If the missing record is subsequently recovered, the information or entries in the replacement record will be inserted in the original record.

The HREC or any part of it should be duplicated whenever it becomes illegible or deteriorates to the point that it may endanger its future use or value as a permanent record. The duplicate record or duplicate portion must reproduce as closely to the original as possible. Pay particular attention to detail when you transcribe this information. When you duplicate an entire health record, place the designation "DUPLICATE RECORD" prominently on the front of the jacket above the wording OUTPATIENT MEDICAL RECORD.

When you duplicate only part of the record, identify the individual forms by printing "DUPLICATE" at the bottom of each form. Enter the circumstances necessitating the duplication and the date accomplished on an SF 600. Microfiche all forms replaced for protection and preservation, and make the envelope a permanent part of the medical record. On front of the envelope, record the member's full name, FMP (family member prefix) and SSN, date of birth, and list the original forms contained in the envelope.

If microfilming is not available to the MTF, place the original health forms (except forms contaminated with mold or mildew) inside a plain envelope for preservation and make them part of the permanent record. On the front of the envelope, record the member's identifying data (same as microfiche envelope) and list the contents of the envelope. Mark the envelope "ORIGINAL MEDICAL RECORDS -PERMANENT" and file as the bottommost item in part 2 of the 4-part health record jacket.

DISPOSING OF HEALTH RECORDS DURING HOSPITALIZATION

When a patient is transferred to an MTF, the HREC should accompany the patient. If members are admitted to a military hospital while away from their command, their HRECs should be forwarded as soon as possible to the hospital. If a discharged member is directed to proceed home and await final action on the recommended findings of a physical evaluation board, an entry to this effect should be recorded in the HREC.

If a member is admitted to a civilian hospital for treatment involving brief periods of hospitalization, the HREC should be retained by the activity until disposition is completed. The HREC will then be forwarded to the cognizant office of medical affairs or to the activity designated by the Commandant of the Marine Corps (CMC) for Marine Corps members. In instances where the parent activity retains the HREC, a summary of the hospitalization will be entered on an SF 600 when the member returns to duty.

When a member is hospitalized at a medical facility of a foreign nation, an entry of this fact should be made in the HREC. The HREC should be retained on board and continued until the patient either returns to duty or is transferred to another U.S. Navy vessel or U.S. military activity. Upon departure of the vessel from the port, the HREC should be delivered to the commanding officer for inclusion in the member's service record for forwarding to the nearest U.S. embassy or consulate.

SECURITY AND SAFEKEEPING OF MEDICAL RECORDS

LEARNING OBJECTIVE: Recall security and safekeeping procedures for medical records.

Each MTF or medical department develops policies to ensure that medical records are secure and a patient's privacy is protected. Security and safekeeping are major concerns and responsibilities of staff handling medical records. The medical record contains information that is personal to patients, treated as privileged information, and protected by the Privacy Act of 1974. The Privacy Act of 1974 protects a patient's right to privacy in respect to personal medical information. The Privacy Act permits only the patients and their legal representatives to obtain this information.

Medical facilities or departments should take precautions to avoid compromise of medical information during the movement and storage of medical records. Medical records should be handled by only authorized medical service personnel. Records should be stored in a locked area, room, or file to ensure safekeeping, unless there is a 24-hour watch in the records room. Refer to the MANMED for more detailed guidelines on medical record security and safekeeping.

RELEASING MEDICAL INFORMATION
LEARNING OBJECTIVE: Recognize guidelines for releasing medical information.

The Surgeon General (also titled Director, Naval Medicine) is the official responsible for administering and supervising the execution of SECNAVINST 5211.5, Department of the Navy Privacy Act Program (PAP), as it pertains to the Health Care Treatment Record System. Additionally, the Office of the Surgeon General authorizes requests for access and amendment to naval members' medical and dental records.

Commanding officers of Navy MTFs are designated as local systems managers for medical records maintained and serviced within their activities. Local systems managers are authorized to release information from health records located within the command if proper credentials have been established. The requesting office or individual will be advised that such information is private and must be treated with confidentiality. In all cases where information is disclosed, an entry must be made on OPNAV Form 5211/9, Record of Disclosure-Privacy Act of 1974, and should include the date, nature and purpose of the disclosure, and the name and address of the person or agency receiving the information. Maintain a copy of any such disclosure requests.