MONTHLY HEALTH REPORT

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP75-00399R000100140131-7
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: December 20, 2016
• Document Release Date: June 9, 2006
• Sequence Number: 131
• Publication Date: September 30, 1970
• Content Type: FORM

FORM 12 asst f ica ion r ^N
25X1
9/30/70 Appr T eedl For Release 200 Id$ca?I 0ffZWQ$effW100140131-7
Approvea or Release - - ,2007-1 -17-13 :
REPORTS INVENTORY
PREPARE IN OUPLICATE
DD5/QTR 14 25X1
I. TITLE OF REPORT (if a fill-in report include Form No.)
2. TYPE
X
STATISTICAL
OF
X
,IARRAT I VE
Monthly Health Report
REPORT
MAC INE-NA;~1E LISTING
PERSONNEL
TRAINING
AD1.11N. GENERAL
3. FUNCTIONAL AREA
LOGISTICS
SECURITY
OTHER (specify)
X
iEDICAL
FINANCE
4. NO. OF COPIES PREPARED
5. FREQUENCY (weekly, monthly, quarterly, etc.)
DISTRIBUTION (No. of components not
2
Monthly
number of copies) 2
7,. FORMAT (memorandum, form
B. ADP PROCESSING
9. DIRECTIVE AUTHORITY REQUIRING REPORT
computer print-out, etc)
YES.
IF YES GIVE ADP PROCESSING NO.
Form
lID
Director of Medical Services
10. PREPARING CO.,IPOt1ENT (include lowest level
II. FEEDER REPORTS (State total number and identify by Title,
contributing information to report)
Form No., or nomenclature. Attach :epz.rate sheet if necessary.)
Medical Branch
None
12, COST FACTORS
P
GRADE
HOURLY HOURS PER COST PER TIMES
RATE X REPORT = REPORT X PREPARED COST PER YEAR
GS 11
$6.50
t
$6.50
12/annum
$78.00
B. COSTS
OF COMPUTER
PRODUCED REPO TS
TOTAL COSTS PER YEAR $76.00
13,. COMPLETE DETAILED JUSTIFICATION FOR THIS REPORT (in addition to directive or authority cited in item 9). IF KNOWN,_
INCLUDE DATE REPORT WAS FIRST STARTED AND COMPONENT WHO ESTABLISHED REQUIREMENT.
This report was first submitted July, 1953 at the request of the Director
of Medical Services. It is a statistical report of the numbers and types of illnesses,
and injuries treated during the month. It is broken into employee/dependent groupings
for each of the above. The report includes detailed information on patients eitbr
hospitalized or referred for additional treatment. All other activities of the
Medical Branch are included in a narrative statement the?eby keeping the Office of
G _- -
GOAL PROPOSED BY COMPONENT FOR THIS REPORT
ESTIMATED SAVINGS
RETAIN AS IS OTHER (explain)
MAN-HOURS
DOLLARS
CHANGE
0
O STAT
D I SCONT I NUE
DATE OF INVENTORY
17. NAME A14D TITLE OF PERSON FURNISHING INFORMATION
18. EXTENSION
Classification