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INDIVIDUAL SICK SLIP DATE - Brookside Associates

date . INDIVIDUAL sick slip . ILLNESS INJURY. LAST NAME-FIRST NAME-MIDDLE INITIAL OF PATIENT ORGANIZATION AND STATION. SERVICE NUMBER/SSN GRADE/RATE. UNIT COMMANDER'S SECTION MEDICAL OFFICER'S SECTION. IN LINE OF DUTY IN LINE OF DUTY. REMARKS DISPOSITION OF PATIENT DUTY QUARTERS. sick BAY HOSPITAL. NOT EXAMINED OTHER (Specify): REMARKS. SIGNATURE OF UNIT COMMANDER SIGNATURE OF MEDICAL OFFICER. DD FORM 689, MAR 63 PREVIOUS EDITIONS ARE OBSOLETE. USAPPC Reset date . INDIVIDUAL sick slip . ILLNESS INJURY. LAST NAME-FIRST NAME-MIDDLE INITIAL OF PATIENT ORGANIZATION AND STATION. SERVICE NUMBER/SSN GRADE/RATE. UNIT COMMANDER'S SECTION MEDICAL OFFICER'S SECTION. IN LINE OF DUTY IN LINE OF DUTY. REMARKS DISPOSITION OF PATIENT DUTY QUARTERS. sick BAY HOSPITAL. NOT EXAMINED OTHER (Specify): REMARKS. SIGNATURE OF UNIT COMMANDER SIGNATURE OF MEDICAL OFFICER. DD FORM 689, MAR 63 PREVIOUS EDITIONS ARE OBSOLETE.

individual sick slip signature of medical officer unit commander’s section signature of unit commander medical officer’s section disposition of patient

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Transcription of INDIVIDUAL SICK SLIP DATE - Brookside Associates

1 date . INDIVIDUAL sick slip . ILLNESS INJURY. LAST NAME-FIRST NAME-MIDDLE INITIAL OF PATIENT ORGANIZATION AND STATION. SERVICE NUMBER/SSN GRADE/RATE. UNIT COMMANDER'S SECTION MEDICAL OFFICER'S SECTION. IN LINE OF DUTY IN LINE OF DUTY. REMARKS DISPOSITION OF PATIENT DUTY QUARTERS. sick BAY HOSPITAL. NOT EXAMINED OTHER (Specify): REMARKS. SIGNATURE OF UNIT COMMANDER SIGNATURE OF MEDICAL OFFICER. DD FORM 689, MAR 63 PREVIOUS EDITIONS ARE OBSOLETE. USAPPC Reset date . INDIVIDUAL sick slip . ILLNESS INJURY. LAST NAME-FIRST NAME-MIDDLE INITIAL OF PATIENT ORGANIZATION AND STATION. SERVICE NUMBER/SSN GRADE/RATE. UNIT COMMANDER'S SECTION MEDICAL OFFICER'S SECTION. IN LINE OF DUTY IN LINE OF DUTY. REMARKS DISPOSITION OF PATIENT DUTY QUARTERS. sick BAY HOSPITAL. NOT EXAMINED OTHER (Specify): REMARKS. SIGNATURE OF UNIT COMMANDER SIGNATURE OF MEDICAL OFFICER. DD FORM 689, MAR 63 PREVIOUS EDITIONS ARE OBSOLETE.

2 USAPPC.


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