AUDIO

DD FORM 689

Individual Sick Slip

New Sick Slip

Document sick call encounter

1. Medical Condition (Brief Description)

ILLNESS

INJURY

Quick select:

2. Date (YYYYMMDD)

3. Patient's Name (Last, First, Middle Initial)

4. DoD ID Number

5. Grade / Rank

6. Organization and Station

7. In Line of Duty

Yes (EPTS)

No (EPTS)

8. Remarks

9. Signature of Unit Commander

10. In Line of Duty

Yes (EPTS)

No (EPTS)

11. Disposition of Patient

DUTY

QUARTERS

SICK BAY

HOSPITAL

NOT EXAMINED

OTHER

12. Remarks

13. Signature of Medical Officer