Summary of Care by Non-Military Medical Provider
The Summary of Care by Non-Military Medical Provider form is essential for documenting Soldiers' medical information. It ensures functional limitations are noted for their profiles, aiding military readiness. This form is vital for all Army components receiving civilian care.
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How do I fill this out?
To fill out the Summary of Care form, start by informing your Chain of Command about your medical issue. Next, ensure that the civilian medical provider completes the form accurately based on their assessment. Finally, submit the completed form to your Primary Care Manager and unit within the stipulated timeframe.
How to fill out the Summary of Care by Non-Military Medical Provider?
1
Communicate any medical concerns to your Chain of Command within 7 business days.
2
Obtain a blank Summary of Care form from your Unit Commander and have it filled by the civilian provider.
3
Submit the completed form along with supporting documents to your Primary Care Manager and Regional Care Coordinator.
4
Ensure the form is reviewed and becomes part of your Service Treatment Record.
5
Keep copies of everything for your records.
Who needs the Summary of Care by Non-Military Medical Provider?
1
Active duty soldiers need this form to document civilian medical treatments.
2
National Guard members require this to ensure their health information is up-to-date.
3
Army Reserve soldiers use this form for compliance during civilian medical consultations.
4
Medical providers need the form to accurately assess and document a Soldier's readiness.
5
Chain of Command leaders use this form to make informed decisions regarding soldier deployability.
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What are the instructions for submitting this form?
To submit the Summary of Care form, you must hand deliver it to your Primary Care Manager and Regional Care Coordinator within 7 business days after your civilian treatment. Additionally, provide copies to your unit chain of command. It's advisable to keep a personal copy for your records.
What are the important dates for this form in 2024 and 2025?
The Summary of Care by Non-Military Medical Provider form is effective from June 2019, and continues to be important for compliance and health assessment. Ensure timely submissions to maintain your medical readiness classification through 2024 and 2025.
What is the purpose of this form?
The purpose of the Summary of Care form is to ensure that civilian medical evaluations for Soldiers are documented meticulously. This documentation aids in the creation of a physical profile, which is vital for each Soldier’s medical readiness. By accurately capturing functional limitations, the form plays a crucial role in maintaining Army readiness.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Data: Contains personal information about the Soldier such as name, rank, and contact information.
- 2. Exam Section: To be completed by the medical provider, covering details of the evaluation and findings.
- 3. Diagnosis: To be filled out by the provider, capturing diagnosis and treatment plans.
- 4. Functional Activities: Assesses the Soldier’s capacity to perform military-related activities.
- 5. Signature: Medical provider’s signature affirming the assessment made on the Soldier.
What happens if I fail to submit this form?
Failure to submit this form may delay the establishment of a Soldier's medical profile. Consequently, this can impact their military readiness classification and ability to deploy.
- Impact on Readiness: Without a submitted form, Soldiers may find themselves unfit for duty unexpectedly.
- Delayed Medical Assessments: Medical reviews and decisions may be postponed, affecting care accessibility.
- Non-compliance Consequences: Neglecting to submit can lead to administrative action within the Soldier’s unit.
How do I know when to use this form?
- 1. Post Civilian Consultation: To document and communicate any treatment received from civilian providers.
- 2. During Profile Development: Essential when developing a physical profile based on medical evaluations.
- 3. For Medical Review Requests: Needed when a unit requests a formal review of a Soldier’s medical readiness.
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