Asbestos Medical Surveillance Program (AMSP)
PRINT ALL INFORMATION IN BALLPOINT PEN. PRESS FIRMLY TO ENSURE THE COPY IS LEGIBLE FOR PROCESSING AND MICROFILMING.
Section One
- Complete all blocks. The military section must be completed only for military personnel. The civilian section must be completed only for civilian personnel.
- The name of the facility and the Unit Identification Code (UIC) must be the medical treatment facility 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 foreign nationals not having a US social security number (SSN), place FN in the space just above the SSN blocks.
- For military personnel, complete the blocks for enlisted (pay grade, rating and NEC) or for officers (pay grade, NOBC, 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. Complete the blocks for shipboard personnel by entering the ship hull number (letters/numbers).
- Complete all dates in the format as written on the form; e.g., YEAR, MONTH, DAY (date of birth, date of x-ray).
- For personnel leaving federal service, both military and civilians, 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 for new employees.
- Check the appropriate status block; e.g., check Navy if the person is active duty Navy, Civilian for non-military personnel.
- Forms with incomplete or missing data in section 1 will be returned until corrections are obtained.
Section Two
For all films read as "COMPLETELY NEGATIVE FOR PNEUMOCONIOSIS," mark BOTH the box above "(PROCEED TO SECTION 5)" AND one of the three boxes labeled "0/-, 0/0, 0/1".
FORM HANDLING AND RETENTION
The B-reader will return to you the original NAVMED 6260/7s along with the chest films. This original must be incorporated in to the patient’s permanent health record. The B-reader will send a copy of the completed NAVMED 6260/7 along with the invoice to NAVENVIRHLTHCEN for processing, entry into the central AMSP computer data registry and microfilming. The medical treatment facility will be notified if errors are found on the form which must be corrected both on the medical record copy and the copy in the central data registry. If the NAVMED 6260/7 is returned as an unreadable chest x-ray, the local provider is responsible for taking appropriate action to obtain a readable chest film to complete the AMSP evaluation.
Content last reviewed on February 27th, 2009.