INDIVIDUAL SICK SLIP - United States Army
INDIVIDUAL SICK SLIP
ILLNESS
INJURY
LAST NAME - FIRST NAME - MIDDLE INITIAL OF PATIENT
DATE ORGANIZATION AND STATION
SERVICE NUMBER/SSN
GRADE/RATE
UNIT COMMANDER'S SECTION IN LINE OF DUTY
REMARKS
MEDICAL OFFICER'S SECTION IN LINE OF DUTY
DISPOSITION OF PATIENT SICK BAY NOT EXAMINED
REMARKS
DUTY
QUARTERS
HOSPITAL OTHER (Specify):
SIGNATURE OF UNIT COMMANDER
DD FORM 689, MAR 63
SIGNATURE OF MEDICAL OFFICER
PREVIOUS EDITIONS ARE OBSOLETE.
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