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Navy Asbestos Medical Surveillance Program (AMSP) Forms and Instructions

Asbestos medical surveillance findings are recorded on two forms.

History and physical form NAVMED 6260/5

B reading form NAVMED 6260/7

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 They have been replaced by PDF files that may be completed electronically or printed and completed by hand.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 usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-amsp@mail.mil, or sent via certified mail (or other method that allows tracking) to NMCPHC at the following address.

Asbestos Program
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 NAVMED 6260/7

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, WG-2294).

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 started working.

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.