Get Naval Forms

Filling out the Naval Forms online can streamline your documentation process and ensure accurate record keeping. This guide provides step-by-step instructions to help users complete the Medical Record - Supplemental Medical Data efficiently and effectively.

Follow the steps to complete your form accurately.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred digital editor.
2. Start by entering the 'Requiring Document' title and number at the top of the form to validate its use.
3. Fill in the 'Issuance Date' to indicate when the form was issued.
4. In the 'Admissions' section, check the appropriate option between 'Eligibility Check ONLY' or 'Inpatient Admission'.
5. Input the patient's full name, including last name, first name, and middle initial, in the designated fields.
6. Provide the patient's birth date in the format DDMMYY, followed by indicating their sex.
7. Record the patient’s religion and family member prefix number.
8. Complete the patient’s home address, including city, state, zip code, and phone number, as well as their work phone.
9. Indicate the patient’s service status, selecting from options such as 'Active Duty,' 'Retired,' etc. Also, include the patient's rank, unit location, and length of service.
10. Fill in the duty station address with city, state, zip code, and contact information.
11. Provide next of kin and emergency information, including the relationship, name, address, and phone details.
12. The admissions office needs to complete the final section, including date and time of admission, clinical service, admitting diagnosis, physician name, and registration number.
13. Remember to have the admitting physician sign and date the form.
14. Add patient identification details including full name, social security number, sex, date of birth, and rank/grade.
15. Submit the completed form by saving your changes, and choose to download, print, or share the form as needed.

Take a moment to complete your documents online and ensure your records are accurately maintained.