This section provides instruction for using certain forms in the health record instead of transcribing their data to the SF 600, Chronological Record of Medical Care.

Narrative Summary (SF 502)
The purpose of the SF 502 is to summarize clinical data relative to treatment received during periods of hospitalization. The narrative summary should include all procedures and diagnoses, and must agree with information listed on the Inpatient Admission/Disposition Report (NAVMED 6300/5) and any information listed in the operation report.

The SF 502 should include the following information:

Reason for hospitalization, including a brief clinical statement of the chief complaint and history of the present illness.
All significant findings.
All procedures performed and treatment given, including patient's response, complications, and consultations.
The condition and relevant diagnosis at the time of patient's transfer or discharge.

Discharge instructions given to patients or their families (i.e., physical activity permitted, medication, diet, and follow-up care).
List of principal providers or attending physicians and their signatures.

A completed copy of the SF 502 should accompany patients who are transferred to another medical facility. Upon discharge from the hospital, a copy of the SF 502 should be taken to the member's parent command. The SF 502 informs the command of any limitations, medications, and follow-up care the service member may need. After command use, the SF 502 should be placed into the member's HREC. For more detailed instruction on the use of the SF 502, refer to the MANMED.

Abbreviated Clinical Record (SF 539)
The SF 539 may be used as a substitute for the narrative summary for those admissions of a minor nature that require less than 48 hours of hospitalization. Acopy of SF 539 should be filed in the HREC.

Consultation Sheet (SF 513)
The SF 513 is used for outpatients who need to be referred to other healthcare providers or specialists, such as gynecologists, internists, optometrists, etc. The primary patient assessment should be entered onto the form. Include as well the results of examinations and tests on the SF 513. The patient remains the responsibility of the referring provider until the specialist takes over the care. In some cases, the specialist will perform an examination or procedure and refer the patient back to the original provider for continued care. The original consultation form stays in the HREC.

Medical Board Report (NAVMED 6100/1)
Whenever a member of the naval service is reported on by a medical board, place a legible copy of the report in the health record instead of transcribing the clinical data to the SF 600. Make a notation on the current SF 600 to indicate the clinical data is contained in the copy of the Medical Board Report incorporated in the health record, when the Medical Board Report is forwarded to the Navy Department for review and appropriate disposition. Enter a report of the departmental action on the current SF 600.

Eyewear Prescription (DD Form 771)
The purpose of DD form 771, Eyewear Prescription (fig. 12-8), is to order corrective prescription eyewear. Depending on its edition date (any of which is authorized), the DD form 771 may consist of a 3-copy carbon form (for use with pen), a 2-part carbonless form (printed on a tractor-feed printer) (fig. 12-8A), or a computer-generated form using virtual copies (fig. 12-8B). The original of the form will be sent to the optical laboratory, and a copy of the form will be placed in the patient's HREC. As with other standard forms, the DD 771 is frequently submitted via computer modem or fax, depending on availability.

Three major areas covered by the DDForm 771 are patient information, prescription information, and miscellaneous information. These three areas are discussed as follows:

1. Patient Information: The specific information required is the patient's name, rank, SSN, duty station, mailing address, and military status. This information is required to establish eligibility and provide the requesting activity with an address for the patient upon receipt of the completed eyeglasses.

2. Prescription Information: Since the spectacle prescription is the technical portion of the order form, you should complete it with great care, ensuring that the prescription is transferred in its entirety. The essential elements of the prescription are interpupillary distance, frame size, temple length, plus and minus designators for both sphere and cylinder powers, segment powers and heights, prism, and prism base. It is not necessary to calculate decentration in the single vision or multifocal portions of the order. It is also unnecessary to try to transpose any prescription into plus or minus cylinder form. Leave the prescription as is, copy it onto the DD Form 771, and note in the remarks section that the prescription has been copied and is in the HREC.

3. Miscellaneous Information: This area is reserved for any information you feel the Navy Optical Laboratory may need. Information the laboratory may need includes special fabrication requirements, such as multifocal lenses, or proof of eligibility for specialized eyewear, such as aviator sunglasses. Standard issue items can be determined from NAVMEDCOMINST 6810.1, Ophthalmic Services.

DD Forms 771 should be typewritten or computer printed whenever possible. This practice eliminates

Figure 12-8.-Eyewear Prescription, DD Form 771: A. Computer-printed edition; B. Computer-generated edition.

any errors by misreading an individual's handwriting. It is critical you take the time to correctly order spectacles. Omission of any information or entering erroneous information will result in a delay at the fabricating facility or a patient's receiving an incorrect pair of eyeglasses, or both.

If you cannot read what has been written on an eyewear prescription, you should contact the optometrist for clarification. In the case where the optometrist cannot be contacted, as a last effort you can send a photostatic copy of the prescription to the optical laboratory, rather than transcribing information of which you are unsure. Make sure that the copy of the prescription is accompanied by a completed DD Form 771.