RECORD NUMBERING.-Each health record jacket has the second to the last digit of the SSN preprinted on it. The preprinted digit also matches the last digit of the form number (e.g., the preprinted digit on NAVMED6150/26 is 6). The color of the treatment record jacket corresponds to the preprinted digit. In preparing a member's treatment record jacket, select a prenumbered NAVMED 6150/20-29 jacket by matching the second to the last number of the member's SSN.

SOCIAL SECURITY NUMBER.-Enter the rest of the member's SSN on the top of the inside back cover. For members who do not have an SSN (e.g., foreign military personnel), use NAVMED 6150/29 as the treatment record jacket. A"substitute" SSN should be created for these members by assigning the numbers "9999" as the last four digits of the SSN and assigning the first five digits in number sequence (e.g., first SSN 000-01-9999, the second SSN 000-02-9999). Place a piece of black cellophane tape over the number that corresponds to the last digit of the SSN in each of the two number scales on the inside back cover of the HREC (fig. 12-2).

FAMILY MEMBER PREFIX.-Enter the member's family member prefix (FMP) code in the two diamonds preceding the SSN on the top of the inside back cover. Enter the FMP code of 20 for all Navy and Marine Corps members. Enter an FMPcode of 00 for all foreign military personnel.

PATIENT'S NAME.-Enter the member's full name (last, first, middle initial, in that order) in the upper-right corner. Indicate no middle name by the abbreviation "NMN." If the member uses initials instead of first or middle names, show this by enclosing the initials in quotation marks (e.g., "J" "C"). Indicate titles, such as JR, SR, and III, at the end of the name. The name may be handwritten on the line provided or imprinted on a self-adhesive label and attached to the jacket in the patient identification box.

ALERT BOX-In the lower center area of the outside front cover, indicate in the alert box whether the member has drug sensitivities or allergies by entering an "X" in the appropriate box. If there are no allergies or sensitivities, leave it blank.

RECORD CATEGORY.-Indicate the appropriate record category by entering an "X" in the box marked "Health Record" on the outside front cover, just below the "Pencil Entries" block. Then attach 1/2-inch red tape to the record category block on the right edge of the inside back cover of the jacket; this indicates it's an active duty record.

PATIENT SERVICE AND STATUS.-Below the record category box is the patient service and status box. Mark an "X" in the appropriate service block.

SPECIAL CATEGORIES OF RECORDS.- Identify the records of personnel assigned to special duty or medical surveillance programs (e.g., personnel reliability program, flight status, or the Asbestos Medical Surveillance Program) by marking an "X" at the appropriate special category entry listed below the record category type.

Identify flag officers and general officers by stamping or printing "FLAG OFFICER" or

Figure 12-2.-Sample of completed outside front cover and inside back cover of a health record jacket (NAVMED 6150/26.)

"GENERAL OFFICER," as appropriate, on the lower portion of the patient identification box. If a patient identification label is used, print or stamp the appropriate identification below the label.

PENCILENTRIES.-Following the instructions on the front cover, pencil in the appropriate title (i.e., grade or rate, if on active duty; preferred form of address, if retired or civilian), and include the current command (if active duty).

RECORD RETIREMENT TAPE BOX.- Leave the record retirement tape box on the inside back cover blank.

BAR CODE.-Some Navy medical facilities have bar coding capabilities. The bar code label indicates the patient's FMP, SSN, record type, and record volume number. Affix the label to the front of the record jacket in the box right of the alert box. If the bar code is part of the patient identification label (such as the patient identification label produced by the Composite Health Care System (CHCS) computers), place this label in the patient identification box.

LABELS.-Use of a self-adhesive label with the name of the MTF, ship, or other units having custodial responsibility for the record is optional. Ship or MTF logos are permitted as long as the necessary patient identifying information is not obscured. For further details see the appropriate MANMED article covering this subject.

Preparing the Inside Front Cover
Enter the following information in pencil on the inside front cover of the HREC jacket. Record the information in the inside of the front cover in pencil to permit changes and updating.

Date of arrival
Projected departure date
Home address and telephone number
Duty station and telephone number

Preparing the Middle Section
The middle section of the HREC contains a preprinted DD 2005, Privacy Act Statement-Health Care Records, on the front side. When opening an HREC, the service members are asked to read the Privacy Act Statement. After the members have read the statement, they will need to sign, date, and include their SSN at the bottom of the form. Signing this statement indicates the service members understand their right to confidentiality in regard to the medical documentation placed in their HREC.

On the reverse of the middle section is a Disclosure Accounting Record. This form should be annotated whenever the HREC is released to any individual or agency outside the MTF.