Get Navmed 6100 5

Filling out the Navmed 6100 5 form accurately is essential for managing limited duty status within military medical evaluations. This guide provides a clear step-by-step process to complete the form online.

Follow the steps to successfully complete the Navmed 6100 5 form.

1. Click 'Get Form' button to retrieve the Navmed 6100 5 form and open it in the appropriate editor.
2. In Section 1, Clinical Information, enter the date, patient name, and patient social security number. Specify the proposed start date for limited duty and the proposed end date. Select the appropriate reason for the limited duty from the provided options, noting any specific referrals necessary depending on the patient's status.
3. Fill in the diagnosis section with the pertinent ICD-9 CM codes, up to three if applicable. Additionally, provide detailed information regarding the circumstances of the injury or illness and outline the treatment plan.
4. Describe any limitations from full duty, including treatment transfers or physical readiness test limitations, if applicable. Ensure signatures are obtained from the MEB member and the coordinating authority.
5. In Section 2, Patient Information, the patient must acknowledge receiving full information about their proposed limited duty. The patient should sign and date this section, confirming their understanding of the process.
6. For Section 3, Patient Administration Officer or Medical Boards Officer, complete the actions performed, such as notifying the personnel office and entering necessary information into MedBOLTT. Ensure to include the printed name, signature, and date of the authorized officer.
7. Once all sections are completed, review the form for accuracy. Save the completed form, then choose to download, print, or share the document as needed, ensuring all copies reach the required parties.

Complete your documents online by following these straightforward steps.