DATA ON FRONT COVER OF THE DENTAL RECORD JACKET

Family Member Prefix (FMP) Codes Enter the patient’s FMP code in the two diamonds preceding the SSN using Table 1-1. DATA ON FRONT COVER OF THE DENTAL RECORD JACKET All entries on the front cover, except “Pencil Entries” are made with black felt-tip pen. Use the following instructions to complete the next sections. Name Enter the patient’s name in the upper-right corner in the following sequence: last, first, middle. Indicate no middle name by the abbreviation “NMN.” The name should be written on the line provided. For all retired flag and general officers (i.e., 0-7 and above), enter the phrase “FLAG OFFICER” or “GENERAL OFFICER,” as appropriate, in the lower portion of the patient’s identification box. Alert Immediately below the instruction box, indicate in the alert box whether the patient has sensitivities or allergies by entering an “X” in the appropriate boxes (if none, leave blank). Pencil Entries Enter the patient’s command and grade or rate for active duty. For all others enter their preferred form of address. Table 1-1.—Family Member Prefix Codes Relationship to Sponsor FMP Code Sponsor’s oldest child (including stepchildren) Sponsor’s next oldest child Sponsor’s third oldest child, etc. Sponsor (active duty, retired, and Reserve uniformed services personnel of Army, Air Force, Marine Corps, Coast Guard, Public Health Service, and National Oceanic and Atmospheric Administration) * Sponsor’s current spouse * Sponsor’s eligible former spouses Sponsor’s family member mother/stepmother Sponsor’s family member mother-in-law Sponsor’s family member father-in-law Other authorized sponsor’s family members Beneficiaries authorized by statute (SECNAV designees, etc.) Non-beneficiary emergencies All other authorized personnel (foreign national, etc.) 01 02 03 20 30 31-39 40-44 50-54 55-59 60-69 90 98 99 * The spouse of a deceased sponsor will continue to use the sponsor’s SSN. If the sponsor had no SSN, use the sponsor’s military serial or service number preceded by leading zeros to complete a 9-digit number. 2-12