Get Veterinary Health Record 2013-2024

VETERINARY HEALTH RECORD PRIVACY ACT STATEMENT AUTHORITY 10 U.S.C. 136 DoD DIrective 5136. 01 Army Regulation 40-905 SECNAVINST 6401-1B AFI 48-131. PRINCIPAL PURPOSE S To establish and maintain health records of animals and to locate animal owners for follow-up notification of care or treatment received* ROUTINE USE S The information may be used to aid in preventive health and communicable disease control programs report medical conditions required by law to Federal state and local agencies. The DoD Blanket Routine Uses found at http //dpclo. defense. gov/privacy/SORNs/blanketroutineuses. html may also apply. DISCLOSURE Voluntary. However if you fail to provide the requested information the animal will not be provided veterinary care. 1. SPONSOR DATA a* NAME Last First Middle Initial b. GRADE OR RANK c* HOME ADDRESS Street City State Zip Code d. PERSONAL TELEPHONE NO. Include Area Code e. DUTY STATUS X one ACTIVE RETIRED g. ORGANIZATION f* RESIDENCE X one ON POST OFF POST h. DUTY PHONE Include Area Code 2. ANIMAL DATA a* NAME b. SPECIES c* BREED d. COLOR e. DATE OF BIRTH f* SEX g. MICROCHIP 3. IMMUNIZATION DATA a* DATE b. VACCINE TYPE DD FORM 2343 AUG 2013 c* MANUFACTURER d. LOT NUMBER PREVIOUS EDITION IS OBSOLETE* Adobe Professional X 4. LABORATORY PROCEDURES b. LABORATORY TEST - RESULT - REMARKS 5. MASTER PROBLEM LIST a* PROBLEM NO. DD FORM 2343 BACK AUG 2013 b. PRINCIPAL PURPOSE S To establish and maintain health records of animals and to locate animal owners for follow-up notification of care or treatment received* ROUTINE USE S The information may be used to aid in preventive health and communicable disease control programs report medical conditions required by law to Federal state and local agencies. The DoD Blanket Routine Uses found at http //dpclo. defense. gov/privacy/SORNs/blanketroutineuses. html may also apply. The DoD Blanket Routine Uses found at http //dpclo. defense. gov/privacy/SORNs/blanketroutineuses. html may also apply. DISCLOSURE Voluntary. However if you fail to provide the requested information the animal will not be provided veterinary care. DISCLOSURE Voluntary. However if you fail to provide the requested information the animal will not be provided veterinary care. 1. SPONSOR DATA a* NAME Last First Middle Initial b. GRADE OR RANK c* HOME ADDRESS Street City State Zip Code d. 1. SPONSOR DATA a* NAME Last First Middle Initial b. GRADE OR RANK c* HOME ADDRESS Street City State Zip Code d. PERSONAL TELEPHONE NO. Include Area Code e. DUTY STATUS X one ACTIVE RETIRED g. ORGANIZATION f* RESIDENCE X one ON POST OFF POST h. PERSONAL TELEPHONE NO. Include Area Code e. DUTY STATUS X one ACTIVE RETIRED g. ORGANIZATION f* RESIDENCE X one ON POST OFF POST h. DUTY PHONE Include Area Code 2. ANIMAL DATA a* NAME b. SPECIES c* BREED d. COLOR e. DATE OF BIRTH f* SEX g. DUTY PHONE Include Area Code 2. ANIMAL DATA a* NAME b. SPECIES c* BREED d. COLOR e. DATE OF BIRTH f* SEX g. MICROCHIP 3. IMMUNIZATION DATA a* DATE b. VACCINE TYPE DD FORM 2343 AUG 2013 c* MANUFACTURER d. LOT NUMBER PREVIOUS EDITION IS OBSOLETE* Adobe Professional X 4. .