2 DENCOM RC Mobilization Station 1 Brief

Slide 1: 

U.S. Army Dental Command Reserve Components Mobilization SRP Station 1 Briefing Revised 10 Oct 2008

Slide 2: 

STATION 1 Record Briefing Entry DENCOM SRP Mobilization Processing Stations Exit U.S. Army Dental Command STATION 2 STATION 3 Radiographs PANX & I/O STATION 4 Dental Exam STATION 5 Soldier Record Outprocessing GO No Yes Record Audit Record Validation

Slide 3: 

Front Jacket Cover Pen: Last Name, First Name, SSNPencil: Unit, Rank Dental Record Blood Type U.S. Army Dental Command

Slide 4: 

U.S. Army Dental Command Medical History Form- DA 5570

Slide 5: 

Doe, John D. x x x 333 rd Medical Company 555-666-9999 555-333-1111 xxx-xx-xxxx x x x x x x x x x Black Ink Answer all questions: 1 thru 15 Check all applicable conditions x x x x U.S. Army Dental Command Medical History Form- DA 5570

Slide 6: 

Each “Yes” answer or checked medical condition requires an explanation. 1. High blood pressure 3. 7. Smoke -1 pack a day 8. Occasionally Penicillin Asthma since I was 5 years old, no medications necessary Write # of checked “YES” answer to explanation. xx Sep xxxx John D. Doe U.S. Army Dental Command Medical History Form- DA 5570

Slide 7: 

U.S. Army Dental Command Dental Validation Form SF603A

Slide 8: 

xxx-xx-xxxx xx-xx-xx x Areas designated with an “x” must be completed in black ink. Format for entries: DOB (DD/MM/YY) Component/Status: AC, ARNG, USAR Dept/Service: USA, USN, USMC, USAF, Civilian Sponsor’s Name: place e-mail address and telephone number if known. Rank/Grade: Military/GS Civilian Organization: Unit Name/Number xxx Xxxx, Xxxx X. xxx xxx xxx xxx.xxx @ us.army.mil (xxx) xxx-xxxx Dental Validation Form SF603A

Slide 9: 

PEN Privacy Act Statement Signature, SSN, Date Location: inside right half of record jacket xx Sep xxxx Complete in Pen xxx-xx-xxxx U.S. Army Dental Command

Slide 10: 

HIPAA NOPP-Notice of Privacy Practices Signature of Patient/Date Printed Name of Patient Social Security Number Location: Backside of record jacket xxx xx xxxx Complete in Pen Doe, John D. xx Sep xxxx John D. Doe U.S. Army Dental Command