Dental Record Forms and Where they Go

Part 1: Inside front cover

  • Unmounted radiographs in envelopes in the front.
  • Sequential bitewing radiographs in the middle.
  • Panographic or full-mouth radiographs in the back.

Part 2: Front of the center page

  • The NAVMED 6600/3 Dental health questionnaire (HQR) goes here.

Part 3: Back of the center page

  • Put all Dental exam forms EZ603 here.
  • Place in reverse chronological order with the Plan P side up and the newest date on top.

Part 4: Inside back cover

  • Place all dental forms in this particular order.
  • But numbered forms must be grouped together with the most recent ones in front.
  • First, record identifier for personal reliability program NAVPERS 5510/1.
  • Second, current status form.
  • Third, Reserve dental assessment and certification form NAVMED 6600/12.
  • Forth, currency dental treatment forms like EZ603A.
  • Fifth, previous dental treatment forms like EZ603As, SF603s, and 603As.
  • Sixth, Narrative summary like SF 502.
  • Seventh, Consultation sheet SF 513.
  • Eighth, Doctor’s progress notes, SF 509.
  • Ninth, Tissue examination, SF 515.
  • Tenth, Request for the administration of anesthesia and for performance operations SF 522.

Additional dental forms

Other dental treatment forms may be approved to be included in the dental records like the Veterans Affairs, Office of Personnel Management, Compensation Act, Standard Forms, optional forms, and civilian practitioner forms.

These forms may be added to the dental records when they pertain to dental care and treatment.

Attach the form to the appropriate approved form as well as summaries of the reports from civilian practitioners in the proper order.

If it’s approved but not attached, then just file inside the back cover of the dental record jacket behind the last authorized form.

Author: John

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