What form is used when the dosimetry record is kept separate from the health record (Charge Out Record)?

• A. OF23
• B. DD Form 1952
• C. SF 600
• D. DD Form 1119

Answer: (A)

When dosimetry records are kept separate from the health record, a charge-out log is used to track who borrows the dosimeter and when it’s due back. The form designated for this purpose is the OF 23, the Charge Out Record. It captures who is taking the dosimeter, the device or badge details, the out date, the expected return date, and signatures, so the dosimeter can be reliably linked to the individual’s dose history even though the dosimetry file sits separately from the health file.

The standard medical record form, SF 600, is used to document medical care within the health record and isn’t meant for tracking loaned dosimetry devices. The other forms listed have different administrative or medical purposes and don’t serve as the charge-out log for dosimetry.