SF 600

Chronological Record of Medical Care

Provider-completed · encounter note

Provider

Component & duty status

Confirm your component. Reserve and Guard members complete the additional items — availability, Line of Duty, and TRICARE Reserve Select drive eligibility and periodicity.

Component

Current duty status

Line of Duty (LOD) status

TRICARE Reserve Select

RC unit / state

Mobilization date (if applicable)

⚠ Reserve Component member — PHA/readiness periodicity follows the drill cycle; complete the Line of Duty and TRICARE Reserve Select items.

Encounter

Date of visit

Provider / clinic

Encounter type

Note

Subjective / Objective / Assessment / Plan (SOAP)

Disposition

Provider attest

Provider: I certify this encounter note.