Dd Form 689, Individual Sick Slip, March 1963 - Glwach

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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
OTHER (Specify):
NOT EXAMINED
REMARKS
SIGNATURE OF UNIT COMMANDER
SIGNATURE OF MEDICAL OFFICER
DD FORM 689, MAR 63
PREVIOUS EDITIONS ARE OBSOLETE.
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