Navmed 6100/6 Form is an important document for healthcare providers to keep in their files. As a legal record, it authenticates individual medical and personal history information that must be filled out correctly. Not only does this form contain vital components of an individual's medical documentation, but it also provides an accurate picture of the patient's current and past activities. Whether you're a new provider or one who has plenty of experience with the Navy Medical Record System, understanding how to accurately complete the Navmed 6100/6 will help ensure the health of your patients as well as minimize any potential risks associated with incorrect filing procedures. In this blog post we'll explain what Navmed 6100/6 Form is used for, its importance when completing records correctly, as well as some tips on how to properly fill out this important form effectively.
| Question | Answer |
|---|---|
| Form Name | Navmed 6100 6 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | 6100 6, dod 61006 duty limited form, navy navmed 61006 form, dod navmed 6100 unrestricted duty |
RETURN OF A PATIENT TO MEDICALLY UNRESTRICTED DUTY
FROM LIMITED DUTY
SECTION 1: CLINICAL INFORMATION - TO BE COMPLETED BY MEDICAL OFFICER
Date: |
|
|
Patient Name: |
|
|
Patient SSN: |
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Last, |
First, MI) |
||||
Diagnosis: |
(1) |
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|
||
|
|
(2) |
|
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
|
Notes on return to duty, including findings, prognosis, and any residual effects:
Effective date (Proposed) of return to Unrestricted Duty:
Printed physician name/signature/date
Returned to duty (select one):
Disapproved
Approved |
Effective date: |
Printed physician name/signature/date
SECTION 2: PATIENT INFORMATION - TO BE COMPLETED BY PATIENT
I have received full information on my "return to duty." I understand that my return to duty becomes effective once approved by the MTF convening authority. The MTF will report my return to medically unrestricted duty to my parent command and I will personally notify my immediate chain of command.
Patient signature/date
SECTION 3: PATIENT ADMINISTRATION/MEDICAL EVALUATION BOARDS OFFICIAL
The following actions have been completed (the completing official will initial and date next to each entry):
Entry into MedBOLTT |
|
Notification to parent command |
Briefing to patient on limited duty/MEBs |
|
Notifications to PSD/personnel office |
|
||
Notification to MTF LIMDU coordinator |
|
|
|
|
Printed patient administration/medical evaluation boards official name, signature, and date
ROUTING: Original to patient health record;copies to patient, parent command, PSD, MEBR case file,
NAVMED 6100/6