END NOTES

[1] A listing of abbreviations, acronyms, and office symbols can be found at Tab A.

[2] Army Regulation 40-66 (AR 40-66), "Medical Record and Quality Assurance Administration," April 1, 1987; Navy Medical Command Instruction 6150.1 (NAVMEDCOMINST 6150.1), "Healt h Care Treatment Records," February 25, 1987; Air Force Regulation 168-4 (AFR 168-4), "Air Force Administration of Medical Activities," April 27, 1990.

[3] Army Regulation 40-66 (AR 40-66), "Medical Record and Quality Assurance Administration," April 1, 1987, sec. IV, p. 21.

[4] Air Force Regulation 28-4 (AFR 28-4), "USAF Mobility Planning," attachment 1, MOP-17, January 8, 1990, p. A1-2-17-3, par. 7.

[5] Army Regulation 40-562, Navy Medical Command Instruction 6230.3, Air Force Regulation 161-13, and Coast Guard Commandant Instruction M6230.4D, "Immunizations and Chemoprophylaxis," October 7, 1988, p. 16.

[6] Army Regulation 40-562, Navy Medical Command Instruction 6230.3, Air Force Regulation 161-13, and Coast Guard Commandant Instruction M6230.4D, "Immunizations and Chemoprophylaxis," October 7, 1988, p. 16.

[7] Army Regulation 40-66 (AR 40-66), "Medical Record and Quality Assurance Administration," April 1, 1987, p. 30; Navy Medical Command Instruction 6150.1 (NAVMEDCOMINST 6150.1), "Health Care Treatment Records," February 25, 1987, p. 10; Air Force Regulation 168-4 (AFR 168-4), "Air Force Administration of Medical Activities," April 27, 1990, pp. 346-7.

[8] Army Regulation 40-66 (AR 40-66), "Medical Record and Quality Assurance Administration," April 1, 1987, p. 18, par. 5-9d and par. 5-9e, and p. 22, table 5-3; Navy Medical Command Instruction 6150.1 (NAVMEDCOMINST 6150.1), "Health Care Treatment Records," February 25, 1987, encl. 1, p. 16; Air Force Regulation 168-4 (AFR 168-4), "Air Force Administration of Medical Activities," April 27, 1990, p. 335, par. 12-43e and p. 339, par. 12-45d.

[9] Army Regulation 40-66 (AR 40-66), "Medical Record and Quality Assurance Administration," April 1, 1987, p. 17, par. 5-7; Navy Medical Command Instruction 6150.1 (NAVMEDCOMINST 6150.1), "Health Care Treatment Records," February 25, 1987, pp. 15-16, par. 7; Air Force Regulation 168-4 (AFR 168-4), "Air Force Administration of Medical Activities," April 27, 1990, p. 339, par. 12-45.

[10] Army Regulation 640-10 (AR 640-10), "Individual Military Personnel Records," August 31, 1989, p. 5, par. 2-9, and p. 22, table 2-3A; Navy Instruction 5212.5C (SECNAVINST 5212.5C), "Navy and Marine Corps Records Disposition Manual," July 11, 1985, SSIC 6150, p. III-6-9; Air Force Regulation 12-50 (AFR 12-50), "Disposition of Air Force Records," vol. II, October 30, 1987, p. 320, table 168-5.

[11] Army Regulation 25-400-2 (AR 25-400-2), "The Modern Army Recordkeeping System (MARKS)," October 15, 1986, p. 96, par. 40-66f; Navy Instruction 5212.5C (SECNAVINST 5212.5C), "Navy and Marine Corps Records Disposition Manual," July 11, 1985, SSIC 6150, p. III-6-9/10; Air Force Regulation 12-50 (AFR 12-50), "Disposition of Air Force Records," vol. II, October 30, 1987, p. 318, table 168-4.

[12] Communications with staff from the Army's Office of The Surgeon General and the Air Force Surgeon General's Office, November 3 and 5, 1998, and April 27, 1999.

[13] Lead Sheet #12848, Interview of aeromedical evacuation technician, September 4, 1997.

[14] Army Memorandum, HSDS for Commander, HSC DENTAC/ADL, Subject: "Disposition of Health Records (Includes Dental Record) Upon Mobilization," August 21, 1990.

[15] Army Regulation 640-10 (AR 640-10), "Individual Military Personnel Records," August 31, 1989, p. 12, par. 7-3.

[16] Air Force Message, HQ TAC/SGX to HQ USAF/SGHR-MRC, Subject: "Exception to AFR 28-4, MOP 17, Deployment of Medical Records in Support of Operation Desert Shield," 241950Z Dec 90.

[17] Air Force Message, from HQ USAF/SGHR, Subject: "Exception to AFR 28-4, MOP 17, Deployment of Medical Records in Support of Operation Desert Shield," 182100Z Jan 91.

[18] National Guard Bureau Message, from Air National Guard/CSS, Subject: "Deployment of Medical Records," 130830Z Jan 91.

[19] Lead Sheet #10934, Interview of hospital corpsman, May 22, 1997.

[20] Department of Defense Investigational New Drug protocol, Administration of Pentavalent Botulinum Toxoid to At-Risk Individuals during Operation Desert Shield, September 14, 1990.

[21] CENTCOM Message, USCINCCENT/CCSG to COMUSARCENTMAIN/SG et al., Subject: "Biological Warfare Vaccination Guidelines," 171632Z Jan 91; Army Message, from ARCENT/CG, Subject: "Biological Warfare Vaccination Guidelines," 060700Z Jan 91.

[22] Army Memorandum, from OTSG/SGPS-PSP, Subject: "Medical Records and Rosters Related to Vaccination Against Biological Warfare Agents," May 21, 1991.

[23] CENTCOM Message, USCINCCENT/CCSG to COMUSARCENTMAIN/SG et al., Subject: "Biological Warfare Vaccination Guidelines," 171632Z Jan 91; Army Message, from ARCENT/CG, Subject: "Biological Warfare Vaccination Guidelines," 060700Z Jan 91.

[24] Department of Defense Letter, Assistant Secretary of Defense for Health Affairs to Commissioner of Food and Drugs, September 13, 1996.

[25] Lead Sheet #5553, Interview of hospital corpsman, July 22, 1997.

[26] Marine Corps Message, 1st MARDIV/CG to All First MARDIV, Subject: "Biological Warfare Vaccination Program," 200932Z Mar 91; Army Letter, from Army Medical Group (Provisional), Subject: "Documentation Guidelines for Anthrax Immunization," July 9, 1991; Army Memorandum for Commanders, Major US Army Reserve Commands, Subject: "Medical Records and Rosters Related to Vaccination Against Biological Warfare (BW) Agents," June 25, 1991; National Guard Bureau Memorandum, All States Log Number 191-0209, Subject: "Medical Records and Rosters Related to Vaccination Against Biological Warfare Agents," June 24, 1991; Army Message, from CDRFORSCOM, Subject: "Medical Records and Rosters Related to Vaccination Against Biological Warfare (BW) Agents," 191755Z Jun 91; Army Memorandum, from OTSG/SGPS-PSP, Subject: "Medical Records and Rosters Related to Vaccination Against Biological Warfare Agents," May 21, 1991.

[27] Lead Sheet #14606, Interview of clearing company physician, March 27, 1998.

[28] Food and Drug Administration, 21 CFR Part 50, Informed Consent for Human Drugs and Biologics: Determination That Informed Consent Is Not Feasible; Interim Rule and Opportunity for Public Comment, Federal Register, December 21, 1990, vol. 55, pp. 52814-52816.

[29] Army Memorandum, HSDS for Commander, HSC DENTAC/ADL, Subject: "Disposition of Health Records (Includes Dental Record) Upon Mobilization," August 21, 1990; Army Regulation 640-10 (AR 640-10), Individual Military Personnel Records, August 31, 1989, p. 12, par. 7-3.

[30] Lead Sheet #14880, Interview of aeromedical technician, April 13, 1998.

[31] Army Message, CDRXVIIIABNCORPS/SURG to COMUSARCENT/SURG, Subject: "Disposition of Medical Records and Medical Record Forms," 211200Z Dec 90.

[32] Army Memorandum, Office of the Surgeon General/SGPS-PSA for Commander, US Army 7th Medical Command, Subject: "Exception to Policy for Use of SF 539 in Minimal Care Cases for Operation Desert Shield," November 23, 1990.

[33] Army Regulation 40-66 (AR 40-66), "Medical Record and Quality Assurance Administration," April 1, 1987, p. 15, table 5-1.

[34] Navy Medical Command Instruction 6150.1 (NAVMEDCOMINST 6150.1), "Health Care Treatment Records," February 25, 1987, p. 11, encl. 1, par. 3c(6); Air Force Regulation 168-4 (AFR 168-4), "Air Force Administration of Medical Activities," April 27, 1990, p. 332, par. 12-41b(2)(p).

[35] Lead Sheet #11167, Interview of hospital commander, October 27, 1997.

[36] Air Force Message, HQ TAC/SGAH to 23 TAC Hospital Deployed/SGR, Subject: "Disposition of Inpatient Records," 272030Z Nov 90.

[37] Air Force Message, HQ AFOMS/SGSB to HQ USAFE/SGAR, Subject: "Contingency Facility Inpatient Reporting Requirements," 181700Z Jan 91.

[38] Army Message, CDRXVIIIABNCORPS/SURG to COMUSARCENT/SURG, Subject: "Disposition of Medical Records and Medical Record Forms," 211200Z Dec 90.

[39] Army Memorandum, Office of the Secretary of the Army/SAIS-PDD for Commander, US Army Central Command (ARCENT), Subject: "Desert Storm Records," February 14, 1991.

[40] Air Force Letters, USCENTAF/IM to Operation Desert Shield/Desert Storm Units/IM, Subject: "Disposition of Records," January 27, 1991 and February 9, 1991; Air Force Letter, SAF/AAIA to HQ AFCC/IMD et al., Subject: "Records Management Update," April 17, 1991.

[41] Lead Sheet #14424, Interview of MASH nurse, February 20, 1998.

[42] Lead Sheet #14606, Interview of clearing company physician, March 27, 1998.

[43] Air Force SAC Medical Lessons-Learned, April 17, 1991; Air Force ATC Medical Lessons-Learned, undated; Air Force Aerospace Medicine Consolidated After-Action Report, January 1992, p 10.

[44] Buttz, Charles L., "Preparation for Overseas Movement: Lessons Learned," Military Medicine 156, November 1991, pp. 639-641.

[45] Navy BUMED Lessons-Learned, #LLCC0-01071, March 1, 1991; Air Force Medical Lessons-Learned, Subject: "Physical Qualifications," undated.

[46] Air Force Letter, USAF Hospital Robins/SGAX to HQ AFLC/SGSP, Subject: "Medical After-Action Report," March 21, 1991.

[47] Marine Corps Command Chronology, 8th Tank Battalion of 2nd Marine Division, April 12, 1991.

[48] Lead Sheet #14436, Interview of medical company first sergeant, March 4, 1998.

[49] Air Force Letter, USAF Hospital Robins/SGAX to HQ AFLC/SGSP, Subject: "Medical After-Action Report," March 21, 1991.

[50] Lead Sheet #17115, Interview of MASH patient administrator, July 1, 1998.

[51] Lead Sheet #5553, Interview of hospital corpsman, July 22, 1997.

[52] Army Memorandum for Record, DASG-HCD for OTSG, Subject: "Drug and Vaccine Usage During Operations Desert Shield/Storm," December 9, 1991.

[53] Presidential Advisory Committee on Gulf War Veterans' Illnesses, Interim Report, February 15, 1996, p. 22.

[54] Lead Sheet #14432, Interview of evacuation hospital nurse, February 26, 1998.

[55] Presidential Advisory Committee on Gulf War Veterans' Illnesses, Interim Report, February 15, 1996, p. 22.

[56] General Accounting Office Report, Defense Health Care: Medical Surveillance Improved Since Gulf War, but Mixed Results in Bosnia, May 13, 1997, p. 17.

[57] Institute of Medicine Report, Health Consequences of Service During the Persian Gulf War: Recommendations for Research and Information Systems, 1996, p. 7.

[58] Lead Sheet #11063, Interview of Fox vehicle commander, June 11, 1997.

[59] Lead Sheet #9882, Interview of air search and rescue member, February 11, 1997.

[60] Lead Sheet #14407, Interview of holding company physician, April 3, 1998.

[61] Air Force HQ ARPC/RC Lessons-Learned, JULLS #52348-71500, May 21, 1991.

[62] Lead Sheet #14911, Interview of evacuation hospital physician, July 8, 1998.

[63] Lead Sheet #7992, Interview of medical unit commander, January 27, 1997.

[64] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992; Navy Manual (NAVMED P-117), "Manual of the Medical Department," December 23, 1994; Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994.

[65] Army Regulation 25-400-2 (AR 25-400-2), "The Modern Army Recordkeeping System (MARKS)," February 26, 1993; Navy Instruction 5212.5D (SECNAVINST 5212.5D), "Navy and Marine Corps Records Disposition Manual," April 22, 1998; Air Force Instruction 37-138 (AFI 37-138), "Records Disposition Policies and Procedures," March 31, 1994; Air Force Manual 37-139 (AFM 37-139), "Records Disposition Schedule," March 1, 1996.

[66] Clines, T., Presentation at Institute of Medicine Workshop on Medical Surveillance and Recordkeeping, Washington, DC, April 16, 1998.

[67] Joint Chiefs of Staff Publication 4-02, "Doctrine for Health Service Support in Joint Operations," April 26, 1995, par. II-9d.

[68] Joint Chiefs of Staff Publication 4-02, "Doctrine for Health Service Support in Joint Operations," First Draft, August 30, 1998.

[69] Joint Chiefs of Staff Point Paper, Subject: "Retention of Wartime and Other Military Operations Documents," November 1998.

[70] Congressional Report, Senate Committee on Veterans' Affairs, "Report of the Special Investigation Unit on Gulf War Illnesses," September 1, 1998, p. 11.

[71] Public Law 105-85 (H.R. 1119), National Defense Authorization Act for Fiscal Year 1998, November 18, 1997, Subtitle F, sec. 765.

[72] Army Form 3349 (DA 3349), "Physical Profile," May 1986; Navy Form 6550/12 (NAVMED 6650/12), "Patient Profile," May 1980; Air Force Form 422 (AF 422), "Physical Profile Serial Report," April 1989.

[73] Army Form 3647 (DA 3647), "Inpatient Treatment Record Cover Sheet," May 1979; Navy Form 6300/5 (NAVMED 6300/5), "Inpatient Admission/Disposition Record," March 1992; Air Force Form 565 (AF 565), "Record of Inpatient Treatment," September 1979; Army Form 8007 (DA 8007), "Individual Medical History," November 1991; Navy Form 6150/20 (NAVMED 6150/20), "Summary of Care," January 1994; Air Force Form 1480A (AF 1480A), "Adult Preventive and Chronic Care Flowsheet," June 1997.

[74] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 29, par. 5-22; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-14, art. 16-13(10); Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 32, par. A5.3.8.

[75] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 32, sec. IV; Army Field Manual 8-10-1 (FM 8-10-1), "The Medical Company: Tactics, Techniques and Procedures," December 29, 1994, app. I.

[76] Communication with staff from the Navy's Bureau of Medicine and Surgery, December 4, 1998.

[77] Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-37, sec. IV.

[78] Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 11, par. 4.16.13.

[79] Air Force Instruction 10-403 (AFI 10-403), "Deployment Planning," May 27, 1998, p. 11, par. 1.5.14.3.

[80] Air Force Regulation 28-4 (AFR 28-4), "USAF Mobility Planning," attachment 1, MOP-17, January 8, 1990, attachment 1, MOP 17, p. A1-2-17-3, par. 7.

[81] Department of Defense Directive 6490.2 (DODD 6490.2), "Joint Medical Surveillance," August 30, 1997; Department of Defense Instruction 6490.3 (DODI 6490.3), "Implementation and Application of Joint Medical Surveillance for Deployments," August 7, 1997.

[82] Department of Defense Memorandum, ASD(HA) for the Surgeons General and the Joint Staff (J-4), Subject: "Policy for Pre- and Post-Deployment Health Assessments and Blood Samples," October 6, 1998.

[83] Joint Chiefs of Staff Memorandum, Director of the Joint Staff for Service Chiefs and Unified Command CINCS, "Deployment Health Surveillance and Readiness," December 4, 1998.

[84] CENTCOM Message, USCINCCENT/CCDC to USCINCEUR/J1/J3 et al., Subject: "USCINCCENT Individual Protection and Deployment Policy for Unit Deployments and Individual Augmentation," 261440Z Sep 96.

[85] CENTCOM Message, USCINCCENT/CCDC to USARCENT et al., Subject: "Individual Protection and Unit Deployment Medical Policy," 250722Z Nov 97; CENTCOM Message, USCINCCENT/CCDC to COMUSARCENT et al., Subject: "Individual Protection and Unit Deployment Policy," 180847Z Feb 98.

[86] EUCOM Message, from USCINCEUR/ECMD, Subject: "Redeployment Medical Screening Guidance for U.S. Personnel Supporting Operation Joint Endeavor," 231639Z Feb 96.

[87] Air Force Joint Instruction 48-110, Army Regulation 40-562, Bureau of Medicine Instruction 6230.15, and Coast Guard Commandant Instruction M6230.4E, "Immunizations and Chemoprophylaxis," November 1, 1995, p. "14-16"; Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 26, par. 5-17; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-71, art. 16-59; Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 34, par. A5.4.2.2.

[88] Navy Memorandum, Chief of BUMED to All Stations, Subject: "Adult Preventive and Chronic Care Flowsheet for Implementation of Put Prevention Into Practice (PPIP)," July 7, 1998; Department of Defense Memorandum, ASD(HA) for Assistant Service Secretaries, Subject: "Put Prevention Into Practice (PPIP) - Policy," March 31, 1998.

[89] Army Letter, from HQDA, Subject: The Use of DD Form 2766 and DD Form 2766C, March 26, 1999.

[90] Air Force Memorandum, from AFMOA/CC, Subject: "Deployment Medical Surveillance," August 17, 1998.

[91] Air Force Pamphlet 44-155, Implementing Put Prevention Into Practice, February 1, 1999, par. 4.1.5.

[92] Food and Drug Administration, 21 CFR Part 50, Accessibility to New Drugs for Use in Military and Civilian Exigencies When Traditional Human Efficacy Studies Are Not Feasible: Determination Under the Interim Rule That Informed Consent is Not Feasible for Military Exigencies; Request for Comments, Federal Register, July 31, 1997, vol. 62, pp. 40996-41001.

[93] Department of Defense Letter, Acting ASD(HA) to Food and Drug Administration, undated.

[94] National Science and Technology Council/Presidential Review Directive-5 Report, A National Obligation: Planning for Health Preparedness for and Readjustment of the Military, Veterans, and Their Families after Future Deployments, August 1998, p. 22.

[95] Persian Gulf Veterans Coordinating Board, Action Plan with Respect to the Final Report of the Presidential Advisory Committee on Gulf War Illnesses (PAC), March 7, 1997, p. 12-13.

[96] Department of Defense Memorandum, ASD(HA) for the Surgeons General and the Chairman of the Joint Chiefs of Staff, Subject: "Policy on Issue and Use of the Antibiotic Ciprofloxacin for the Post-Exposure Treatment of Anthrax," March 5, 1998.

[97] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 22, figure 5-2; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-55, art. 16-37(17); Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 36, par. A5.4.3 and p. 59, par. A12.4.3.

[98] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 80.

[99] Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-7.

[100] Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, par. 4.4.2, A8.11, and A9.3.

[101] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 31, par. 5-26; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-14, art. 16-13(10) and p. 16-26, art. 16-21; Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 45, par. A8.4.

[102] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 6, par. 1-5; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-9, art. 16-10; Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 3, par. 2.2.1.

[103] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 29, par. 5-21; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-51, art. 16-37; Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, attachment 3.

[104] Department of Defense Directive 6000.14 (DODD 6000.14), "Patient Bill of Rights and Responsibilities in the Military Health System (MHS)," July 30, 1998.

[105] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 20, par. 5-2; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-55, art. 16-37(17); Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 11, par. 4.16.15 and 4.16.16.

[106] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 32, par. 5-27; Army Regulation 25-400-2 (AR 25-400-2), "The Modern Army Recordkeeping System (MARKS)," February 26, 1993, FN: 40-66a; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-24, art.16-20; Navy Instruction 5212.5D (SECNAVINST 5212.5D), "Navy and Marine Corps Records Disposition Manual," April 22, SSIC 6150(1), 1998, p. III-6.4; Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 46, par. A8.7; Air Force Manual 37-139 (AFM 37-139), "Records Disposition Schedule," March 1, 1996, p. 539, table 41-12.

[107] Department of Defense/Department of Veterans Affairs (DOD/VA) Memorandum of Understanding, "The Transfer/Loan of Military Health (Medical & Dental) Treatment Records to VA," October 1995; Army Message, from PERSCOM/TAPC-PDT-T, Subject: "Mailing Health Records of Transitioning Soldiers to VA," 251000Z Sep 92; Navy Message, CNO to NAVADMIN, Subject: "Transfer of the Navy Health (Medical and Dental) Treatment Records," 261423Z Jan 94; Air Force Instruction 36-2608 (AFI 36-2608), "Military Personnel Records System," July 1, 1996, table A6.3, p. 138; Marine Corps Message, CMC/M-RA to ALMAR, Subject: "Revised Procedures for Transfer of Health Records Upon Discharge or Release from Active Duty," 151005Z Apr 94; National Personnel Records Center Information Sheet, June 1998.

[108] Department of Defense/Department of Veterans Affairs (DOD/VA) Memorandum of Understanding, "The Transfer/Loan of Military Health (Medical & Dental) Treatment Records to VA," October 1995.

[109] Marine Corps Message, CMC/M-RA to ALMAR, Subject: "Revised Procedures for Transfer of Health Records Upon Discharge or Release From Active Duty," 151005Z Apr 94; General Accounting Office Letter, David P. Baine to John D. Rockefeller IV, May 4, 1994.

[110] Department of Defense Memorandum, ASD(HA) for Assistant Service Secretaries, Subject: "Policy Memorandum-DOD/VA Separation Physical Examination," September 28, 1998.

[111] Army Regulation 40-66 (AR 40-66), "Medical Record Administration," July 20, 1992, p. 48, par. 8-8.

[112] Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-55, art. 16-37(17); Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 11, par. 4.16.15 and 4.16.16.

[113] Army Regulation 40-66(AR 40-66), "Medical Record Administration," July 20, 1992, p. 48, par. 8-8; Army Regulation 25-400-2 (AR 25-400-2), "The Modern Army Recordkeeping System (MARKS)," February 26, 1993, FN: 40-66f; Navy Manual P-117 (NAVMED P-117), "Manual of the Medical Department," December 23, 1994, p. 16-34, art. 16-25(9); Navy Instruction 5212.5D (SECNAVINST 5212.5D), "Navy and Marine Corps Records Disposition Manual," April 22, SSIC 6150(2), 1998, p. III-6.4; Air Force Instruction 41-210 (AFI 41-210), "Patient Administration Functions," July 26, 1994, p. 11, par. 4.16.14; Air Force Manual 37-139 (AFM 37-139), "Records Disposition Schedule," March 1, 1996, p. 536, table 41-11.

[114] Department of Defense Memorandum, ASD(HA) for Assistant Secretary of the Army (M&RA) et al., Subject: "Disposition of Field Medical Records For Operations Desert Shield/Storm," July 12, 1994.

[115] Army Memorandum, OTSG for ASD(HA) Subject: "Disposition of Field Medical Records For Operations Desert Shield/Storm," August 4, 1994; Air Force Memorandum, SAF/MRAI&E for ASD(HA), Subject: "Disposition of Field Medical Records For Operations Desert Shield/Storm," August 11, 1994.

[116] Army Message, DAMO-OMO to CDR Coalition Task Force Kuwait, Subject: "Army Recordkeeping for Southwest Asia," 011258Z Apr 98.

[117] Clines, T., Presentation at Institute of Medicine Workshop on Medical Surveillance and Recordkeeping, Washington, DC, April 16, 1998.

[118] Christopherson, Gary A., Statement before the House Committee on Veterans' Affairs, Subcommittee on Health, April 23, 1998.

[119] Department of Defense Directive 6490.2 (DODD 6490.2), "Joint Medical Surveillance," August 30, 1997; Department of Defense Instruction 6490.3 (DODI 6490.3), "Implementation and Application of Joint Medical Surveillance for Deployments," August 7, 1997.

[120] Department of Defense Instruction 6490.3 (DODI 6490.3), "Implementation and Application of Joint Medical Surveillance for Deployments," August 7, 1997, p. 6, par. F2d(4) and p. 9, par. F4a(1).

[121] Department of Defense Memorandum, ASD(HA) for the Surgeons General and the Joint Staff (J-4), Subject: "Policy for Pre- and Post-Deployment Health Assessments and Blood Samples," October 6, 1998.

[122] Christopherson, Gary A., Statement before the House Committee on Veterans' Affairs, Subcommittee on Health, April 23, 1998.

[123] Congressional Report, House Committee on Government Reform and Oversight, Subcommittee on Human Resources, "Gulf War Veterans' Illnesses: VA, DOD Continue to Resist Strong Evidence Linking Toxic Causes to Chronic Health Effects," November 7, 1997, p. 133.

[124] Institute of Medicine Report, Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action, January 1995, p. 9.

[125] Presidential Advisory Committee on Gulf War Veterans' Illnesses, Final Report, December 31,1996, pp. 28 and 52.

[126] Persian Gulf Veterans Coordinating Board, Action Plan with Respect to the Final Report of The Presidential Advisory Committee on Gulf War Veterans' Illnesses, March 7, 1997, pp. 13-15.

[127] Congressional Report, "Commission on Servicemembers and Veterans Transition Assistance," January 14, 1999, pp. 7 and 99.

[128] Department of Defense, Military Health System Data Administration Conference, May 20-21, 1998, Bethesda, MD.

[129] Presidential Advisory Committee on Gulf War Veterans' Illnesses, Special Report, October 31, 1997, pp. 9-10.

[130] Shays, Christopher C., Statement for the House Committee on Government Reform and Oversight, Subcommittee on Human Resources, May 14, 1998.

[131] General Accounting Office Report, Gulf War Veterans: Incidence of Tumors Cannot Be Reliably Determined From Available Data, March 3, 1998, p. 3; General Accounting Office Testimony, Kwai-Cheung Chan, before the House Committee on Government Reform and Oversight, Subcommittee on Human Resources, Gulf War Veterans: Limitations of Available Data for Accurately Determining the Incidence of Tumors, May 14, 1998, pp. 1, 4-6, and 9-10.

[132] Department of Defense Letter, Acting ASD(HA) to General Accounting Office, January 21, 1998.

[133] General Accounting Office Report, Defense Health Care: Medical Surveillance Improved Since Gulf War, but Mixed Results in Bosnia, May 13, 1997, pp. 17, 20, and 30-31.

[134] Department of Defense Memorandum, ASD(HA) for the Service Secretaries, Subject: "Health Documentation for Deployed Members of the Armed Services," February 24, 1999.

[135] Communication with staff from Department of Defense (P&R)(JR&IO), April 29, 1998.

[136] Department of Defense (Personnel & Readiness) (Joint Requirements & Integration Office), Statement of Mission and Responsibilities, DoD(P&R)(JR&IO) web site, www.mpm.osd.mil (as of June 11, 1999).

[137] Department of Defense (Personnel & Readiness) (Joint Requirements & Integration Office), Project Descriptions, DoD(P&R)(JR&IO) web site, www.mpm.osd.mil (as of June 2, 1999).

[138] Department of Defense Report to Congress, "The Transfer of Service Medical Records," August 5, 1994.

[139] General Accounting Office Letter, David P. Baine to John D. Rockefeller IV, May 4, 1994.

[140] Communication with staff from the National Personnel Records Center (NPRC), June 18, 1998.

[141] Electronic Data Systems, Department of Defense/National Archives and Records Administration Medical Records Disposition Management Final Report, September 25, 1996; Electronic Data Systems, Department of Defense/National Archives and Records Administration Medical Treatment Records Management BPR and Time-Phased Implementation Plan, December 15, 1995.

[142] Department of Defense Report to Congress, "Medical Tracking System for Members Deployed Overseas," May 1998, pp. 16-17.

[143] General Accounting Office Testimony, Stephen P. Backhus, before the House Committee on Veterans' Affairs, Veterans' Benefits: Improvements Made to Persian Gulf Claims Processing, February 5, 1998.

[144] Navy COMNAVDOCCOM Lessons Learned, JULLS #LLWE0-03651, April 7, 1995.

[145] Marine Corps MAG-31 Lessons Learned, JULLS #10112-08717, March 21, 1994.

[146] Department of Defense (Office of the Special Assistant for Gulf War Illnesses) News Release, "DoD Database Helps Locate Gulf War Hospital Records," August 4, 1998.

[147] White House Press Release, "Statement by the President: Special Report of the Presidential Advisory Committee on Gulf War Veterans' Illnesses," November 8, 1997.

[148] Air Force News Release, "Leaders Unfold Plan to Modify, Strengthen TRICARE," February 3, 1999; Montgomery, Michael, Briefing, Patient Administration Y2K: Supporting the Operational Continuum, February 3, 1999.

[149] Department of Defense, Military Health System Strategic Plan, DoD (Health Affairs) web site, www.ha.osd.mil (as of August 3, 1998).

[150] Department of Defense, Medical Readiness Strategic Plan 1998-2004, DoD 5136.1-P, August 1998, pp. 93-94.

[151] Department of Defense (Health Affairs), Strategic Thinking Assumptions-Health Affairs and the Military Health Services System in 1998, DoD (Health Affairs) web site, www.ha.osd.mil (as of July 31, 1998).

[152] Christopherson, Gary A., Statement before the Senate Committee on Veterans' Affairs, March 17, 1998.

[153] Martin, Edward D., Statement before the House Appropriations Committee, Subcommittee on Defense, February 12, 1998.

[154] Christopherson, Gary A., Statement before the Senate Committee on Armed Services, Subcommittee on Personnel, March 11, 1998.

[155] Department of Defense (Health Affairs) Draft Concept Paper, Computer-based Patient Record, Department of Defense (Health Affairs) web site, www.tricare.osd.mil (as of June 8, 1999); Cohn, Jean and Celli, Marian, Briefing, A Computer-based Patient Record: The DoD Enterprise Solution for Improving Care Delivery, April 15, 1999.

[156] Computer-based Patient Record Institute web site, www.cpri.org (as of April 6, 1999); Rizzo, Eric N., "Overview of Computerized Patient/Medical Records," University of Miami web site, www.ece.miami.edu (as of February 17, 1998); National Research Council, For the Record-Protecting Electronic Health Information, Washington, DC, National Academy of Sciences, 1997, National Academy Press web site, www.nap.edu (as of July 27, 1998).

[157] Communication with staff from DoD (Health Affairs), April 28, 1999.

[158] G-CPR Framework Project, CIO Executive Briefing, May 1999.

[159] Army Memorandum, Defense Supply Service-Washington for D/SIDDOMS II, Lot III Contractors, Subject: G-CPR Framework Vendor Selection Process, May 1, 1998.

[160] Ray, Lynn, Briefing to Mr. William Delaney from Senator Leahy's Office, December 15, 1998.

[161] Department of Defense, Technology Information Center, Multi-Technology Automated Reader Card Pilot Project Description, Defense Technology Information Center web site, www.dtic.mil (as of July 30, 1998).

[162] Department of Defense Handbook (MIL-HDBK-50l), Portable Information Carrier, April 15, 1997.

[163] Department of Defense (Public Affairs) News Release, "Force Medical Protection," November 6, 1997; Blanck, Ronald R., Briefing to DoD Press Corps, Medical Force Protection, November 6, 1997.

[164] Department of Defense (Health Affairs), Information Management Program Review Board Meeting, January 28, 1998, DoD (Health Affairs) web site, www.ha.osd.mil (as of May 18, 1998).

[165] American Forces Press Service, "Proving Ground Tests DOD's Digital Dog Tags," Defense Technology Information Center web site, www.dtic.mil (as of July 30, 1998); Army Letter, US Army Medical Research Acquisition Activity, Subject: Request for Proposal DAMD17-99-R-0001, March 17, 1999.

[166] National Science and Technology Council/Presidential Review Directive-5 Report, A National Obligation: Planning for Health Preparedness for and Readjustment of the Military, Veterans, and Their Families after Future Deployments, August 1998, p. 22 and p. 6.

[167] Department of Veterans Affairs, Telemedicine Information, VA web site, www.va.gov (as of February 17, 1998 and June 2, 1999); Army Surgeon General Information Paper, Telemedicine Proliferation, October 1997, Army web site, www.amedd.army.mil (as of January 23, 1998).

[168] Army Medical Research and Materiel Command web site, www.armymedicine.army.mil (as of August 3, 1998).

[169] Department of Defense, Theater Medical Information Program, Tri-Service Center for Total Analysis web site, www.cta.ha.osd.mil (as of April 2, 1998).

[170] Department of Defense Report to Congress, "Medical Tracking System for Members Deployed Overseas," May 1998, p. 10.

[171] Department of Defense (Health Affairs), CHCS II Program Office web site, www.cba.ha.osd.mil (as of July 31, 1998).

[172] Department of Defense Report to Congress, "Medical Tracking System for Members Deployed Overseas," May 1998, p. 8-9.

[173] Department of Defense (Health Affairs), Clinical Business Area PHCA Update Briefing, January 12, 1999; Department of Defense (Health Affairs), PHCA Overview on PHCA Project web site, www.cba.ha.osd.mil (as of May 27, 1999).

[174] Department of Defense Report to Congress, "Medical Tracking System for Members Deployed Overseas," May 1998, pp. 8-9.

[175] Department of Defense Report to Congress, "Medical Tracking System for Members Deployed Overseas," May 1998, pp. 6-7.

[176] Department of Defense Report to Congress, "Medical Tracking System for Members Deployed Overseas," May 1998, p. 17.

[177] National Science and Technology Council/Presidential Review Directive-5 Report, A National Obligation: Planning for Health Preparedness for and Readjustment of the Military, Veterans, and Their Families after Future Deployments, August 1998, p. 19.

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