Part 1: Preparing the inside front cover
Start off by following the information in pencil on the inside front cover of the record jacket. Record the information in pencil and this will allow you to make changes and keep updating throughout the member’s career.
- Date of arrival
- Projected rotation date
- Home address and telephone number
- Command UIC and telephone number
Part 2: Preparing the front of the center page
The Imprint of DD 2005, Privacy Act Statement is a pre-printed form. It is located in front of the center page in the record jacket.
This form must be signed and dated in Black ink by the patient, the parent, or the guardian (if the patient is a minor).
Part 3: Preparing the back of center page
The Disclosure Accounting Record is a pre-printed form that is located on the back of the center page of the record jacket.
This form should be filled out as needed. This part provides the beginning of how disclosure and release of information will be handled.
Part 4: Preparing the inside back cover
The Forensic Examination form is pre-printed and located inside the back cover of the record jacket and should be completed if the record is going to be used for dental care.