Navy Asbestos Medical
Surveillance Program (AMSP) Forms and Instructions
Asbestos medical surveillance findings
are recorded on two forms.
History and physical form NAVMED
B reading form NAVMED
Both forms previously were
multipart, carbon copy forms. They have been replaced by PDF files that may
be completed electronically or printed and completed by hand.
History and physical form
NAVMED 6260/5 is completed (for each asbestos worker at EVERY asbestos
surveillance visit) in its entirety at the Medical Treatment Facility (MTF).
After completion, it is to be copied and placed in the medical record; the
copy is to be sent as an attachment of an encrypted email to email@example.com, or sent via certified
mail (or other method that allows tracking) to NMCPHC at the following
Navy and Marine Corps Public Health Center
620 John Paul Jones Cir, Ste 1100
Portsmouth, VA 23708-2103
B reading form NAVMED 6260/7 is
completed only when asbestos workers are due for a chest X-ray (see
NMCPHC - TM OM 6260 Medical Surveillance Procedures Manual and
Medical Matrix). Section 1 is completed at the MTF. That form is
sent (or, if the old carbon copy form is used, the original and the copy are
sent) with the CD or DVD containing the chest X-ray images to the B reader.
The B reader will complete the form and send the form, with the CD or DVD,
to NMCPHC. The completed NAVMED 6260/7 is faxed (or attached to an encrypted
email) to the MTF, to be placed in the worker's medical record.
GUIDELINES FOR COMPLETING
Complete the top of the form
except CONTROL NUMBER and complete all blocks in Section 1. The form may be
completed by hand or using a computer. If completed using a computer, the
form should be printed but should not be saved, as it would contain
Personally Identifying Information (PII).
The name of the facility and
the Unit Identification Code (UIC) are those of the MTF taking the X-ray.
For civilians, the job code and
occupational service code is a 2 letter plus 4 digit number (e.g., GS-0018,
For military personnel,
complete the blocks for enlisted (pay grade, rating, and Navy Enlisted
Classification) or for officers (pay grade, Navy Officer Billeting
Classification, and designator).
For Marines, place the 4 digit
Military Occupational Specialty (MOS) code in the NEC block. Place the
Warrant Officer Occupation Codes in the officer designator block.
For both military and civilian
personnel leaving federal service, check Termination Examination in the exam
purpose block, regardless of whether any previous examination was done.
For years of government service
less than one year, enter 01. Enter 00 only for new employees who have not
Check the appropriate status
block (e.g., check Navy if the person is active duty Navy, check Civilian
for non-military personnel).
When completed using a
computer, "Invalid" will be displayed in red until all required data in
Section 1 has been entered. Invalid forms must not be submitted. If the
document is printed (e.g., to be completed by hand), the "Invalid" notation
does not print. After the top and Section 1 are completed (and the PDF form
reads "valid," if completed using a computer), print and send the form with
the CD (or DVD) to the B reader. There is currently no mechanism to email
NAVMED 6260/7 to the B reader.