Military Health History Card For Print

Unique Health Risks
Environmental Exposures
Asbestos Burn Pit Smoke Contaminated water (benzene, trichloroethylene, vinyl chloride) Endemic Diseases Hexavalent Chromium Ionizing & Non-Ionizing Radiation Jet Fuel Lead Nerve Agents Particulate Matter Pesticides TCDD & other dioxins
Military Health History

POCKET CARD FOR CLINICIANS
Answers to the questions inside this card...

...will provide you with information helpful in understanding patients' medical problems and concerns, and in establishing rapport and therapeutic partnerships with military service members and Veterans. Answers may also provide a basis for timely referral to specialized medical resources.
Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn (OEF/OIF/OND)
Animal Bites/Rabies Combined Penetrating Blunt Trauma Burn Injuries (Blast Injuries) Dermatologic Issues Embedded Fragments (shrapnel) Leishmaniasis Mental Health Issues Multi-Drug Resistant Acinetobacter Reproductive Health Issues Spinal Cord Injury Traumatic Amputation Traumatic Brain Injury Vision Loss
Oce of Academic Aliations

www.va.gov/oaa/pocketcard/
Gulf War
Chemical or Biological Agents Depleted Uranium (DU) Dermatologic Issues Immunizations Infectious Diseases (i.e., Leishmaniasis) Oil Well Fires Reproductive Health Issues
Oce of Public Health

www.publichealth.va.gov
www.warrelatedillness.va.gov
War-Related Illness and Injury Study Center
Vietnam
Agent Orange Exposure Hepatitis C
www.publichealth.va.gov/vethealthinitiative/
Veterans Health Initiative Independent Study Courses
Cold War
Nuclear Weapons Testing (Atomic Veterans)
Information for Veterans: Compensation and Pension Benets

www.vba.va.gov/bln/21
WWII/Korea
Agent Orange Exposure Cold Injury Chemical Warfare Agent Experiments Exposure to Nuclear Weapons (Including Testing or Cleanup)
IB 10-463, P96532 February, 2012
Office of Academic Affiliations

VETERANS HEALTH ADMINISTRATION
Ask these questions of military service members and all Veterans

General Questions
Tell me about your military experience. When and where do you/did you serve? What do you/did you do while in the service? How has military service aected you?
Exposure Concerns
What... were you exposed to? Chemical (pollution, solvents, etc.) Biological (infectious disease) Physical (radiation, heat, vibration, noise, etc.) precautions were taken? (Avoidance, PPE, Treatment) How long was the exposure? concerned are you about the exposure? Where... were you exposed? When... were you exposed? Who... else may have been aected? Unit name, etc.
If your patient answers "Yes" to any of the following questions, ask:
"Can you tell me more about that?"

Did you see combat, enemy re, or casualties? Were you or a buddy wounded, injured, or hospitalized? Did you ever become ill while you were in the service? Were you a prisoner of war?
Hepatitis C Virus (HCV) Infection

Have you ever had a blood transfusion? Have you ever injected drugs such as heroin or cocaine?
Living Situation Compensation & Benefits

Do you have a service-connected condition? Would you like assistance in ling for compensation for injuries/illnesses related to your service?
Where do you live? Is your housing safe? Are you in any danger of losing your housing? Do you need assistance in caring for dependents?
Stress Reactions/Adjustment Problems

In your life, have you ever had an experience so horrible, frightening, or upsetting that, in the past month you...
Call VBA at 1-800-827-1000

Sexual Harassment, Assault, and Trauma
Have you ever experienced physical, emotional, or sexual harassment or trauma? Is this past experience causing you problems now? Do you want a referral?
Have had nightmares about it or thought about it when you did not want to? Tried hard not to think about it or went out of your way to avoid situations that reminded you of it? Were constantly on guard, watchful, or easily startled? Felt numb or detached from others, activities, or your surroundings?
Personal Health Journal Online Rx rell VA benets & resources Manage your health
Tell your patient about VAs

Gateway to Veteran Health Benefits and Services
www.myhealth.va.gov

Military Health History Card For Print

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Military Health History Card For Print

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Unique Health Risks

Military Health History

Answers to the questions inside this card...

Oce of Academic Aliations

Oce of Public Health

War-Related Illness and Injury Study Center

Veterans Health Initiative Independent Study Courses

Information for Veterans: Compensation and Pension Benets

IB 10-463, P96532 February, 2012

Office of Academic Affiliations

Ask these questions of military service members and all Veterans

If your patient answers "Yes" to any of the following questions, ask:

"Can you tell me more about that?"

Hepatitis C Virus (HCV) Infection

Living Situation Compensation & Benefits

Stress Reactions/Adjustment Problems

Call VBA at 1-800-827-1000

Tell your patient about VAs

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