SF507

Medical Record

Agency
GSA
Revision
Rev. 7/1991
Fillable fields
9
Pages
2
Official source
GSA form page
Checked
October 20, 2026
Fill SF507 online
Page 1 of form SF507

Standard Form 507 (SF 507): Medical Record

Standard Form 507 (SF 507), Medical Record, is a general medical record page, Rev. 7/1991. Its footer reads Prescribed by GSA/ICMR, FIRMR (41 CFR) 201-9.202-1. GSA hosts a copy in its forms library.

The top of the page is used either as a Report on a type of examination or data, or as a Continuation of another Standard Form. The form says to strike out one line and to specify the type of examination or data, and prints (Sign and date) above the open writing area. The bottom identifies the patient, with a register number, a ward number and a repeat of the report or continuation entry.

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Top of page 1 of Standard Form 507 (SF 507): Medical Record, as printed by GSA

What's on SF 507

Report on or continuation lines

Two lines at the top: Report on, or Continuation of S.F. The form says to strike out one line and specify the type of examination or data.

Open writing area

A blank area for the report or the continued entries, headed (Sign and date), with (Continue on reverse side) at the bottom.

Patient's identification

Name (last, first, middle), grade, rank, rate and hospital or medical facility, with a register number and a ward number.

Report on or continuation box

A repeat at the bottom right, Report on or Continuation of, next to the Medical Record title and footer.

How to complete SF 507

  1. 1

    Choose report or continuation

    The form says to strike out one of the two lines at the top and to specify the type of examination or data.

  2. 2

    Write the entries

    Use the open area for the report or the continued entries. The form says to continue on the reverse side.

  3. 3

    Sign and date

    The form prints (Sign and date) at the top of the writing area.

    Sign and date on page 1 of Standard Form 507 (SF 507): Medical Record, as printed by GSA
  4. 4

    Identify the patient

    For typed or written entries, give the name (last, first, middle), grade, rank, rate and hospital or medical facility, plus the register and ward numbers.

  5. 5

    Repeat the entry at the bottom

    Fill in the Report on or Continuation of box above the footer to match the header.

The form prints short directions in its header. These steps follow its blocks.

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Records and what the form says

Where it goes

The PDF gives no filing address or routing instructions.

Edition

The footer reads Standard Form 507 (REV. 7-91). GSA's page lists the current revision date as 07/1991.

Prescribing rule

The footer reads Prescribed by GSA/ICMR, FIRMR (41 CFR) 201-9.202-1. GSA's page lists the authority as FIRMR (41 CFR) 201-9-202-1.

Reverse side

The front says to continue on the reverse side. The second page of the PDF on GSA's page is blank.

Related forms

Who uses SF 507?

  • The person making the entry

    The form prints (Sign and date) at the top of the writing area. It does not name a role.

  • The patient

    For typed or written entries, the patient's identification asks for the name (last, first, middle), grade, rank, rate and hospital or medical facility.

  • The hospital or medical facility

    The facility is named in the patient's identification, next to a register number and a ward number.

  • Records that continue another form

    When the page continues another Standard Form, the Continuation of S.F. line and the bottom box say which one.

The form does not say who writes the report. Its blocks name these entries.

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Questions about Form SF507

Who prescribes SF 507?

The footer says the form is prescribed by GSA/ICMR under FIRMR (41 CFR) 201-9.202-1. GSA hosts a copy in its forms library.

What is SF 507 used for?

The top of the form reads Report on, or Continuation of S.F., and says to strike out one line and specify the type of examination or data.

Can SF 507 continue another Standard Form?

One of its two header lines is Continuation of S.F., and the box at the bottom repeats Report on or Continuation of.

Does SF 507 have a signature line?

It has no separate signature line. The form prints (Sign and date) at the top of the writing area.

What goes in the patient's identification?

For typed or written entries, the form asks for the name (last, first, middle), grade, rank, rate and hospital or medical facility, with a register number and ward number beside it.