CHARGEOUT FORM.\NAVMED 6150/7, Health Record Receipt (fig. 2-11), should be used for chargeout control of dental records. A receipt is prepared for each dental record established and should be filed in the record. The following should be recorded in each health record receipt when the treatment record is received:

Patient's name (last, first, middle).

Sponsor's grade or rate.

Patient's FMP code and sponsor's SSN.

Ship or station to which sponsor is assigned. Use home address for retired personnel and their family members and for those family members of active duty personnel when the sponsor is assigned duty out of the area.

When a patient checks his or her record out, ensure the date block is filled out and that the member signs

Figure 2-11.\NAVMED 6150/7, Health Record Receipt.

his or her name and to what location they are taking the record. The completed chargeout form should be retained in the terminal digit file until the record is returned. Records charged out from the file should be returned as soon as possible after the patient's visit, but not more than 5 working days. Addressees shall develop local procedures for the recovery of delinquent treatment records.

CHARGEOUT GUIDE.\If open-shelf filing is used for dental records, a chargeout guide may be used in conjunction with the chargeout form. A chargeout guide is a plastic "folder" with a "pocket." The chargeout form should be placed in the pocket and the chargeout guide placed in the file in place of the patient's record until the record is returned. By using different colored chargeout guides to denote the day or week that a record is charged out from the file, a quick reference is provided.

Records Review

Also included in your duties for the upkeep of dental records is records review. You may be responsible to identify inactive records, verify records, and to process dental records that are illegible or contaminated.

INACTIVE RECORDS.\Dental records become eligible for retirement because of inactivity. However, allowances will be made for longer sponsor tours of duty, extensions of the sponsor's projected rotation date, and back-to-back tours of duty in the same area. Problems arise as a result of premature retirement of a dental record of a patient who has not requested treatment during the previous 2-year period. Dental records are not retired without an attempt to verify the sponsor's duty status and location. To retire records, you should use MANMED, Article 16-20.

VERIFICATION OF RECORDS.\Dental records should be verified for accuracy when transferred, retired, or at other times as directed by the director of the DTF. At these times, records should be reviewed for proper identification, placement of forms, and completion of the record jacket according to MANMED, Chapter 6. Listed below are some of the specifics of record verification procedures that you will look at:

Verify the record with the patient present, if possible.

Cross-check the military patient's name or sponsor's name against a current roster of the patient's or sponsor's last known unit. This is essential.

Verify that the Privacy Act statement has been signed.

Verify that pencil entries are complete and accurate.

Verify the treatment plan is current (i.e., the treatment plan is not over 12 months old).

Appoint the patient for treatment if the patient is dental class 3. Appoint the patient for a T-2 examination if the patient is dental class 1 or 2 and 12 months or more have elapsed since the last T-2 examination.

ILLEGIBLE OR CONTAMINATED DENTAL RECORDS.\For individual records, duplicate dental record forms whenever they approach a state of illegibility or deterioration or become contaminated, and the future use or value as permanent records is endangered. The duplicate forms must be a reproduction of the original as much as possible. Enter the designation DUPLICATE RECORD on the front of the NAVMED 6150/21-30 above the block Dental Treatment Record when the entire contents of a dental record is duplicated. Use bold writing to make it stand out. When only part of the dental record is duplicated, identify the individual forms as DUPLICATE at the bottom of each form. MANMED, Article 16-19 provides further guidance on illegible or contaminated dental records.

REQUEST FOR MEDICAL/DENTAL RECORDS INFORMATION.\Occasionally, dental records may be left behind at a members previous duty station. Some commands may elect to mail dental records to the next duty station for personnel who transfer. Whatever the case may be, the Request for Medical/Dental Records or Information Form, DD 877, is used as shown in figure 2-12. The requesting DTF will complete blocks 1 through 10, (except 8b) and block 19. The DTF who receives the DD 877 will retrieve and verify the requested dental record(s) and will complete blocks 8b and blocks 11 through 14 or 15 through 18. The requesting DTF will keep the top copy and the DTF who retrieves the dental record will keep the second copy. Files are set up for the DD 877 and arranged in alphabetical order. The DD 877 is sent via U.S. Mail.