| No. |
Désignation |
| Form 1 |
Report of change of status civilian employees Medical Department |
| Form 2 |
Certificate of authority hospital unit Organized Reserves |
| Form 5 |
Purchase description card |
| Form 6 |
Receiving report. (MSD) |
| Form 7a |
Item procurement card "A" (MSD) |
| Form 7b |
Item procurement card "B" (MSD) |
| Form 8a |
Contrat and purchase order card "A" (MSD) |
| Form 8b |
Contrat and purchase order card "B" (MSD) |
| Form 11 |
Stock record card (MSD) |
| Form 12 |
Stock report card (MSD) |
| Form 13 |
Shipping ticket (MSD) |
| Form 14 |
Daily journal of receipts and issues (MSD) |
| Form 16a |
Issue slip, expendable medical property |
| Form 16b |
Issue slip, nonexpendable medical property |
| Form 16c |
Credit slip, nonexpendable medical property |
| Form 16d |
Credit clip, nonexpendable medical property |
| Form 17 |
Return of medical property cover card cover |
| Form 17a |
Return of medical property slip, original |
| Form 17b |
Return of medical property slip, retain |
| Form 17c |
Return of medical property cover card and back |
| Form 18b |
Statement of expenditure of special dental materials |
| Form 18b-L |
Statement of expenditure of special dental materials - Central Dental Laboratory |
| Form 20 |
Caution slip (for packing cases containing medical supplies) (MSD) |
| Form 21 |
Hospital laundry list |
| Form 25 |
Public voucher for medical attendance |
| Form 25a |
Public voucher for medical attendance - memorandum |
| Form 27 |
Public voucher for hospital care and treatment |
| Form 27a |
Public voucher for hospital care and treatment - memorandum |
| Form 28 |
Public voucher for personal services - nursing |
| Form 28a |
Public voucher for personal services - nursing - memorandum |
| Form 39 |
Circular advertisement and proposal for laundry work |
| Form 40 |
Abstract of proposals (large) |
| Form 40a |
Abstract of proposals (small) |
| Form 42 |
Contract for laundry work |
| Form 42a |
Contract for laundry work appendix sheet "A" |
| Form 44 |
Contract with a private physician for full-time service as a contract surgeon U.S. Army |
| Form 44a |
Special contract with a private physicia for services as contract surgeon U.S. Army (limited service) |
| Form 49 |
Statement of the Hospital Fund |
| Form 49a |
Employee's certificate of indebtedness for hospital service |
| Form 51 |
Report sheet for report of sick and wounded |
| Form 52 |
Register card |
| Form 52a |
Index of patients (card) |
| Form 52b |
Emergency Medical Tag (20 in Booklet in Duplicate) |
| Form 52c |
Field medical card |
| Form 52d |
Field medical record jacket |
| Form 52e |
Transfer slip |
| Form 52 C-1 |
Clinical record, physical examination |
| Form 52-9 |
Hospital record of death |
| Form 53 |
Clearing station tag |
| Form 54 |
Surgeon's request for service record |
| Form 55 A |
Clinical record, brief |
| Form 55 B |
Clinical record, chief complaint, condition on admission, previous personal history |
| Form 55 C-2 |
Clinical record, special examination or additional data |
| Form 55 D |
Clinical record, initial summary, working diagnosis, contemplated laboratory tests and consultations |
| Form 55 E-1 |
Clinical record, consultation request and report |
| Form 55 E-2 |
Clinical record, ophthalmologic examination |
| Form 55 E-3 |
Clinical record, ear, nose and throat examination |
| Form 55 E-4 |
Clinical record, dental examination |
| Form 55 E-5 |
Clinical record, dental report |
| Form 55 E-6 |
Clinical report, proctoscopic examination |
| Form 55 E-7 |
Clinical record, urologic examination |
| Form 55 E-8 |
Clinical record, gynecologic examination |
| Form 55 E-9 |
Clinical record, allergy examination |
| Form 55 F |
Clinical record, progress notes |
| Form 55 G-1 |
Clinical record, treatment |
| Form 55 G-2 |
Clinical record, diabetic report |
| Form 55 H-1 |
Clinical record, temperature, treatment, nurse's notes |
| Form 55 H-2 |
Clinical record, temperature, graphic chart |
| Form 55 I |
Clinical record, graphic chart |
| Form 55 J |
Clinical record, electrocardiograph report |
| Form 55 K-1 |
Clinical record, radiologic record |
| Form 55 K-2 |
Clinical record, radiologic report |
| Form 55 K-3 |
Clinical record, record of roentgen therapy |
| Form 55 K-4 |
Clinical record, record of radium therapy |
| Form 55 L |
Clinical record, laboratory reports |
| Form 55 L-1 |
Clinical record, blood |
| Form 55 L-2 |
Clinical record, blood (chemistry) |
| Form 55 L-3 |
Clinical record, serology |
| Form 55 L-4 |
Clinical record, spinal fluid |
| Form 55 L-5 |
Clinical record, urinalysis |
| Form 55 L-6 |
Clinical record, urinalysis (quantitative) |
| Form 55 L-7 |
Clinical record, sputum |
| Form 55 L-8 |
Clinical record, gastric analysis |
| Form 55 L-9 |
Clinical record, feces |
| Form 55 L-10 |
Clinical record, carbohydrate tolerance |
| Form 55 L-11 |
Clinical record, renal function (conc. or dil.) |
| Form 55 L-12 |
Clinical record, renal function (P.S.P.) |
| Form 55 L-13 |
Clinical record, renal function (urea clearance) |
| Form 55 L-14 |
Clinical record, basal metabolism |
| Form 55 L-15 |
Clinical record, miscellaneous |
| Form 55 M |
Clinical record, pathological examination of tissue |
| Form 55 N |
Clinical record, physiotherapy record |
| Form 55 O-1 |
Clinical record, preoperative examination and anesthetic record |
| Form 55 O-2 |
Clinical record, operation report |
| Form 55 O-3 |
Clinical record, authorization for operation or spinal puncture |
| Form 55 P |
Clinical record, fracture record |
| Form 55 Q-1 |
Clinical record, prenatal record |
| Form 55 Q-2 |
Clinical record, labor record |
| Form 55 Q-3 |
Clinical record, neonatal record - sex |
| Form 56 |
Malarial register |
| Form 57 |
Report of dental services |
| Form 58 |
Physical reconstruction register |
| Form 59 |
Report of examination for sergeant, staff sergeant, technical sergeant and master sergeant, Medical Department |
| Form 59a |
Report of examination for sergeant, staff sergeant, technical sergeant and master sergeant, Medical Department (TACTICAL) |
| Form 59b |
Report of examination for sergeant, staff sergeant, technical sergeant and master sergeant, Medical Department (VETERINARY) |
| Form 60 |
Certificate of proficiency, general enlisted men, MD field hospital or ambulance company |
| Form 60a |
Certificate of proficiency, enlsited men Medical Department detachment |
| Form 60b |
Certificate, enlisted speacialists' courses, Medical Department Proffesional Service Schools |
| Form 60c |
Certificate or proficiency, Army Nurse Corps (Anesthetist) |
| Form 61 |
Certificate of identity (in books of 100 sheets each) |
| Form 62 |
Efficiency report, Army Nurse Corps |
| Form 63 |
Report of physical examination |
| Form 64 |
Morning report, Army Nurse Corps |
| Form 65 |
Dental engaement slip |
| Form 66 |
Record of assignment and pay, Army Nurse Corps |
| Form 67 |
Diploma, basic courses, Army Medical School |
| Form 67a |
Diploma, basic courses, Army Dental School |
| Form 67b |
Certificate of graduation, Medical Field Service School |
| Form 67c |
Certificate of proficiency special subjects, Medical Field Service School |
| Form 67d |
Diploma, basic courses, Army Veterinary School |
| Form 67e |
Diploma, basic courses, Army Veterinary School |
| Form 67f |
Certificate of internship in Army Hospitals |
| Form 67g |
Certificate, advanced courses Army Medical School |
| Form 67h |
Certificate, advanced courses, Army Dental School |
| Form 67j |
Certificate, advanced courses, Army Veterinary School |
| Form 67k |
Certificate, hospital training courses in anesthesia or laboratory technic for nurses |
| Form 67m |
Certificate, hospital training courses in physiotherapy |
| Form 67n |
Certificate, hospital traininng courses in dietetics |
| Form 67p |
Certificate, hospital training courses in occupational therapy |
| Form 68 |
Nurse's bedside notes |
| Form 70 |
Chief surgeon's directory (card) |
| Form 71 |
Surgeon's morning report of sick |
| Form 71V |
Veterinarian's morning report of sick animals |
| Form 72 |
Morning report of ward |
| Form 72a |
Consolidated morning report of wards |
| Form 73 |
Diet Card |
| Form 74 |
Mess account |
| Form 75 |
Patient's property card |
| Form 76 |
Patient's property tag |
| Form 77 |
Venereal prophylaxis slip |
| Form 78 |
Syphilitic register |
| Form 78a |
Treatment record |
| Form 79 |
Register of dental patients (card) |
| Form 81 |
Immunization register |
| Form 85 |
Vital statistic chart |
| Form 85a |
Vital statistics chart (small) |
| Form 86ab |
Statistical report, first and second sections |
| Form 86c |
Statistical report - third section (personnel and transportation) |
| Form 86f |
Report of casualties |
| Form 88 |
Record of physical examination |
| Form 90 |
Efficiency and preference report of master, technical, and staff sergeants, Medical Department |
| Form 94 |
Report of sanitary chemical analysis of water |
| Form 95 |
Report of bacteriological examination of water |
| Form 97 |
Record of serological reactions for syphilis |
| Form 99 |
Gonococcis fixation card |
| Form 100 |
Recruit depot Wassermann card |
| Form 101 |
Veterinary health certificate |
| Form 102 |
Veterinary report of sick and wounded animals |
| Form 103a |
Veterinary sanitary report of animal transport |
| Form 109 |
Record and report physical examination of animals for purchase |
| Form 110 |
Report of veterinary meat and dairy hygiene and forage inspection |
| Form 113 |
Trip report veterinary transport service |
| Form 115 |
Register card for sick and wounded animals |
| Form 115a |
Index card register of animal patients |
| Form 115b |
Emergency veterinary tag (20 in book in duplicate) |
| Form 116 |
Receipt for animals (50 in book in duplicate) |
| Form 123 |
Label, penalty (for mailing dental appliances) |
| Form 124 |
Prosthetic case record |
| Form 125 |
Caution slip (for mailing cases containing dental appliances) |
| Form 126 |
Report of central dental laboratories |
| Form 140 |
Report of a contact of veneral disease |
| Form 200 |
Report of survey |
| Form 322a |
Abstract of funds received from sales of medicines to civilians (exhibit to account current) |
| Form 351 |
Voucher for commutation of rations in hospital |
| Form 352 |
Voucher for purchase of medicines on prescriptions |
| Form 354 |
Voucher for examining and vaccinating recruits by civilian physicians |
| Form 377 |
Voucher for reimbursement of medical bills |
| Form 445 |
Requisition |
| Form 446 |
Property issue slip |
| Form 446a |
Property issue slip requisition |
| Form 447 |
Property turn-in slip |
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