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SF600

This document is a medical record template that includes a chronological record of medical care, detailing patient information, symptoms, diagnosis, treatment, and the treating organization. It emphasizes the importance of privacy under the Privacy Act of 1974 and the use of Social Security Numbers for identification. The form is intended for official use only and is authorized for local reproduction.

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220 views2 pages

SF600

This document is a medical record template that includes a chronological record of medical care, detailing patient information, symptoms, diagnosis, treatment, and the treating organization. It emphasizes the importance of privacy under the Privacy Act of 1974 and the use of Social Security Numbers for identification. The form is intended for official use only and is authorized for local reproduction.

Uploaded by

humbertocornier
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MEDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE

PRIVACY ACT STATEMENT: This information is subject to the Privacy Act of 1974 (5 U.S.C. Section 552a). This information
may be provided to appropriate Government agencies when relevant to civil, criminal or regulatory investigations or prosecutions.
The Social Security Number, authorized by Public Law 93-579 Section 7 (b) and Executive Order 9397, is used as a unique
identifier to distinguish between employees with the same names and birth dates and to ensure that each individual's record in
the system is complete and accurate and the information is properly attributed.

DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)

HOSPITAL OR MEDICAL FACILITY STATUS DEPARTMENT/SERVICE RECORDS MAINTAINED AT

SPONSOR'S NAME SOCIAL SECURITY/ID NUMBER RELATIONSHIP TO SPONSOR

PATIENT'S IDENTIFICATION: (For typed or written entries, give: Name - last, first, middle; ID NUMBER or REGISTER NUMBER WARD NUMBER
Social Security Number; Gender; Date of Birth; Rank/Grade.)

CHRONOLOGICAL RECORD OF MEDICAL CARE


Medical Record
STANDARD FORM 600 (REV. 8/2018)
Prescribed by GSA/ICMR
FIRMR (41 CFR) 201-9.202-1

FOR OFFICIAL USE ONLY


PREVIOUS EDITION IS NOT USABLE When Filled Out
AUTHORIZED FOR LOCAL REPRODUCTION
DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)

STANDARD FORM 600 (REV. 8/2018) BACK

FOR OFFICIAL USE ONLY


When Filled Out

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