CUI // PRVCY — Demonstration environment · notional data only
CUI (when filled in) // PRVCY / HLTH
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Adult Preventive & Chronic Care Flowsheet — Continuation

DD FORM 2766C · MAR 1998 Forms menu
Patient: SMITH, Dana R. DoD ID: 1234500000 Continuation of: DD 2766 Records maintained at: NMC Portsmouth

DD 2766C · Continuation sheet

Flowsheet continuation

Continuation of the DD 2766 flowsheet for tests and immunizations whose dated history exceeds the base form. Rows in blue dashed carried over from the DD 2766 record.

Test / frequency / dates
TestFrequency (a)(b)(c)(d)(e)(f)
Remarks
Patient identification & records maintained at
Controlled by: DHA   CUI Category: PRVCY, HLTH   LDC: FEDCON
POC: dha.ncr.bus-ops.mbx.dha-formsmanagement@mail.mil   (Updated 20250320)
DD FORM 2766C, MAR 1998 · Page 1 of 1
Notional sample data. Saving appends the continuation to the DD 2766 record.
CUI (when filled in) // PRVCY / HLTH
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