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US Coast Guard Command Instructions
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> Chronological Record of Medical Care
Miscellaneous Factors.
Chronological Record of Medical Care (Cont)
Public Health and Disease Concerns Related to Coast Guard Operations
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CHRONOLOGICAL
RECORD
OF
MEDICAL
CARE
HEALTH
RECORD
DATE
SYMPTOMS,
DIAGNOSIS,
TREATMENT,
TREATING
ORGANIZATION
(Sign
each
entry)
AMIO
SCREENING
OVERPRINT
Females:
not
pregna
nt
SUBJECTIVE
:
_____
year
old
male
/
female
(circle)
with
a
_____
day
history
of:
blood
in stools
pregnant
nausea
vomiting
diarrhea
abdominal
pain
fever
rash
open
sores
/
cuts
unknown
cough
dizziness
/
fainting
spells
other
symptoms
___________________
no
symptoms
Other
family
members
ill:
Recent
travel:
Current
medications
:
OBJECTIVE:
General:
well
nourished,
well
hydrated
moderately
ill
appearing,
mildly
dehydrated
non-combative
combative
not alert / not oriented
alert & oriented
Other observations:
ASSESSMENT
/
PLAN:
Individual
is
stable,
no
medical
intervention
needed
Individual
is not
stable,
medical
attention required. Contact
medical
personnel
for
assistance.
Additional
precautions:
_____________________________
SIGNATURE
RECORDS
PATIENT'S
IDENTIFICATION
(Use
this
space
for
MAINTAINED
Mechanical
Imprint)
AT:
PATIENT'S
NAME
(
Last,
First, Middle initial )
SEX
RANK
/
GRADE
RELATIONSHIP
TO
SPONSOR:
STATUS
SPONSOR'S
NAME
ORGANIZATION
DEPART./SERVICE
SSN/IDENTIFICATION
NO.
DATE
OF
BIRTH
AMIO
SCREENING
OVERPRINT
CHRONOLOGICAL
RECORD
OF
MEDICAL
CARE
STANDARD
FORM
600
(EF
)
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