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14
HEALTH RECORD (USED IN LIEU OF A STANDARD FORM 600)
DATE
SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING, ORGANIZATION (SIGN EACH ENTRY)
Health records terminated by reason of expiration of enlistment. Auth: MILPERSMAN 1910-104
No further entries this page *************************************
DISCHARGE DATE
IMMEDIATELY REENLISTED
NAME (First Middle Last)
RATE
SOCIAL SECURITY NUMBER
BRANCH AND CLASS
NAVPERS 1070/615 RECORD OF DISCHARGE FROM THE U.S. NAVY RESERVE. (REV 08-06)
S/N: 0106-LF-133-2300
Page 3 of 3
PART 3 – HEALTH RECORD COPY
FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE
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