Standard Form 506 (SF 506): Medical Record - Physical Examination

Standard Form 506 (SF 506), Medical Record - Physical Examination, is a two-sided medical record form, Rev. 5/2025. Its footer reads Prescribed by GSA/ICMR FPMR (41 CFR) 101-11.203(b)(10). The form is marked Authorized for Local Reproduction. GSA hosts a copy in its forms library.

The front records the date of exam, height, weight (average, maximum and present), temperature, pulse and blood pressure, then prints instructions to describe 23 numbered areas, from general appearance and mental status to skin and lymphatics. The back continues the examination and ends with an initial impression and the physician's signature and name. The front also identifies the patient, the sponsor and the hospital or medical facility.

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Top of page 1 of Standard Form 506 (SF 506): Medical Record - Physical Examination, as printed by GSA

What's on SF 506

Vital signs row

Date of exam, height, weight in three boxes (average, maximum and present), temperature, pulse and blood pressure.

Examination instructions

Instructions to describe 23 numbered areas: general appearance and mental status, head and neck, eyes, ears, nose, mouth, throat, teeth, chest, breast, lungs, cardiovascular, abdomen, hernia, genitalia, pelvic, rectal, prostate, back, extremities, neurological, skin and lymphatics.

Patient, sponsor and facility

Relationship to sponsor, sponsor's name and ID number, department/service, hospital or medical facility, records maintained at, patient's identification, register number and ward number.

Continuation on the back

The back starts with last name, first name, middle initial and ID number, then a Physical Examination area for the findings that continue from the front.

Initial impression and signature

An Initial Impression box, then the signature of physician and the name of physician.

How to complete SF 506

1
Record the vital signs
Enter the date of exam, height, the three weight boxes, temperature, pulse and blood pressure along the top of the front.
2
Describe each area
The instructions say to describe the 23 numbered areas, from (1) general appearance and mental status to (23) lymphatics. The front says to continue on the reverse side.
3
Identify the patient and sponsor
For typed or written entries, the form says to give the name (last, first, middle), ID number or SSN, sex (male or female), date of birth and rank/grade, plus the sponsor details.
4
Add the facility details
Fill in the department/service, the hospital or medical facility, where records are maintained, and the register and ward numbers.
5
Repeat the name on the back
Enter the last name, first name, middle initial and ID number at the top of the back, then continue the examination.
6
Record the impression and sign
Write the initial impression. The back ends with the signature of physician and the name of physician.

The form prints instructions for the examination area. These steps follow its blocks.

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Records and what the form says

Where it goes

The PDF gives no filing address. A block on the form records where the records are maintained.

Edition

The footer reads Standard Form 506 (Rev. 5/2025). GSA's page lists the current revision date as 05/2025.

Prescribing rule and copies

The footer reads Prescribed by GSA/ICMR FPMR (41 CFR) 101-11.203(b)(10). The form is marked Authorized for Local Reproduction.

Who fills out SF 506?

The physician
The back has a Signature of Physician line and a Name of Physician box, below the initial impression.
The hospital or medical facility
Blocks record the department/service, the hospital or medical facility and where the records are maintained, with a register number and ward number.
The patient
The patient's identification block asks for the name, ID number or SSN, sex, date of birth and rank/grade. The back repeats the last name, first name, middle initial and ID number.
The sponsor
A row records the relationship to sponsor and the sponsor's name and ID number (Social Security Number (SSN) or other).

The form does not say who records the examination. Its blocks name these roles and places.

Official sources and the blank

Official GSA form page
The agency’s own page for Form SF506.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form SF506

Who prescribes SF 506?

The footer says the form is prescribed by GSA/ICMR under FPMR (41 CFR) 101-11.203(b)(10). GSA hosts a copy in its forms library.

What does the examination section cover?

The instructions list 23 numbered areas to describe, including general appearance and mental status, head and neck, eyes, ears, lungs, cardiovascular, abdomen, extremities, neurological, skin and lymphatics.

Which vital signs does SF 506 record?

The top row records the date of exam, height, weight (average, maximum and present), temperature, pulse and blood pressure.

Who signs SF 506?

The back has a Signature of Physician line next to a Name of Physician box. The front has no signature line.

Can SF 506 be copied locally?

The top of the front is marked Authorized for Local Reproduction.

Standard Form 506 (SF 506): Medical Record - Physical Examination