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Office of Operational Medicine and Quality Improvement (CG-1121) - Manuals, Instructions and Forms

Medically Related Manuals and Instructions

INSTRUCTION NUMBER TITLE
CIM 6000.1F MEDICAL MANUAL
CI 6010.2E COAST GUARD AUXILIARIST SUPPORT TO COAST GUARD HEALTH CARE FACILITIES
CIM 6120.8B MEDICAL EXAM OF APPLICANTS FOR ACADEMY, ROTC, & USUHS (JOINT PUB)
CI 6150.3A COAST GUARD PERIODIC HEALTH ASSESSMENT (PHA)
CI 6150.4 DISPOSITION OF HEALTH RECORDS
CI 6220.4 INFECTION PREVENTION AND CONTROL PROGRAM FOR COAST GUARD HEALTH CARE FACILITIES AND WORKERS
CI 6220.9A PUBLIC HEALTH AND DISEASE CONCERNS RELATED TO COAST GUARD OPERATIONS
CIM 6230.3D COAST GUARD ANTHRAX VACCINE IMMUNIZATION PROGRAM (AVIP)
CIM 6230.4G IMMUNIZATIONS AND CHEMOPROPHYLAXIS (JOINT PUBLICATION)
CIM 6230.9A COAST GUARD HUMAN IMMUNODEFICIENCY VIRUS (HIV) PROGRAM
CIM 6230.10B COAST GUARD SMALLPOX VACCINE PROGRAM (SVP)
CIM 6320.20  AEROMEDICAL EVACUATION, A GUIDE FOR HEALTH CARE PROVIDERS (JOINT PUB)
CIM 6320.8B MEDICAL REGULATING TO AND WITHIN THE CONTINENTAL U.S. (JOINT PUB)
CI 6400.1C STUDENT EXTERNSHIP PROGRAMS (SEP)
CIM 6410.3A COAST GUARD AVIATION MEDICINE MANUAL
CI 6510.1A USING THE ARMED FORCES REPOSITORY OF SPECIMEN SAMPLES FOR THE IDENTIFICATION OF REMAINS (AFRSSIR)
HSWL SC TD STANDARDIZED HEALTH SERVICES TECHNICIAN DRUG FORMULARY (CAC Required)
CIM 6700.5C HEALTH SERVICES ALLOWANCE LIST, ASHORE
HSWL SC TD HEALTH SERVICES ALLOWANCE LIST, AFLOAT (CAC Required)
CI 6700.7B HEALTH SERVICES ALLOWANCE LIST, PART III (SHORE UNITS AND VESSELS)

Other Helpful Manuals and Instructions

INSTRUCTION NUMBER TITLE
CIM 1001.28C RESERVE POLICY MANUAL
CIM 1020.8H COAST GUARD WEIGHT AND BODY FAT STANDARDS PROGRAM MANUAL
CI 1734.1A SUICIDE PREVENTION
CIM 1770.9A MILITARY PERSONNEL CASUALTIES AND DECEDENT AFFAIRS
CIM 1754.10E SEXUAL ASSAULT PREVENTION AND REPONSE PROGRAM (SAPR)
CIM 1850.2D PHYSICAL DISABILITY EVALUATION SYSTEM
CIM 4061.5A COAST GUARD FOOD SERVICE MANUAL
CIM 5100.47C SAFETY AND ENVIRONMENTAL HEALTH MANUAL
CIM 5212.12A INFORMATION AND LIFE CYCLE MANAGEMENT MANUAL
CIM 5216.4C THE COAST GUARD CORRESPONDENCE MANUAL

Medically Related Forms

Vision Questionnaire

All forms can be found on the CG-612 web site. Below are common forms used by medical. If you would like a form added to the list below contact the appropriate program manager.

FORM NUMBER FORM TITLE
CG-4920 EVALUEE'S STATEMENT REGARDING THE FINDINGS OF THE MEDICAL BOARD REPORT
CG-5214 EMERGENCY MEDICAL TREATMENT REPORT
CG-5684 MEDICAL BOARD COVER SHEET
CG-6049 PERSONAL FITNESS PLAN
DD-877 REQUEST FOR MEDICAL/ DENTAL RECORDS
DD-2215 REFERENCE AUDIOGRAM
DD-2216 HEARING CONSERVATION DATA
DD-2569 THIRD PARTY COLLECTION PROGRAM/ MEDICAL SERVICES ACCOUNT/ OTHER HEALTH INSURANCE
DD-2807-1 REPORT OF MEDICAL HISTORY
DD-2808 REPORT OF MEDICAL EXAMINATION
DD-2813 DEPARTMENT OF DEFENSE ACTIVE DUTY/ RESERVE FORCES DENTAL EXAMINATION
DD-2870 AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR DENTAL INFORMATION
DD-2871 REQUEST TO RESTRICT MEDICAL OR DENTAL INFORMATION
DD-2992 MEDICAL RECOMMENDATION FOR FLYING DUTY
SF-513 CONSULTATION SHEET
SF-600 CHRONOLOGICAL RECORD OF CARE
SF-603 DENTAL CHART
SF-603a (modified) DENTAL CONTINUATION (MODIFIED)