Standard Form 510 (SF 510): Medical Record - Nursing Notes

Standard Form 510 (SF 510), Medical Record - Nursing Notes, is a two-sided medical record sheet, Rev. 5/2025. Its footer reads Prescribed by GSA/ICMR FPMR (41 CFR) 101-11.203. The form is marked Authorized for Local Reproduction and says the previous edition is NOT usable. GSA hosts a copy in its forms library.

Each side is a table with the date, the hour (A.M. or P.M.), an Observations column that says to include medication and treatment when indicated, and a Signatures column. The heading says Sign all notes. The front also identifies the patient, the sponsor and the hospital or medical facility, and the back repeats the patient's name and ID number.

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Top of page 1 of Standard Form 510 (SF 510): Medical Record - Nursing Notes, as printed by GSA

What's on SF 510

Date and hour

A Date column and an Hour column split into A.M. and P.M. on each row.

Observations

A wide Observations column, which says to include medication and treatment when indicated.

Signatures

A Signatures column on each row, under a heading that says Sign all notes.

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.

Back of the form

Last name, first name, middle initial and ID number at the top, then the same Nursing Notes table.

How to complete SF 510

1
Date and time each note
Enter the date, then the hour under A.M. or P.M.
2
Record the observations
The column heading says to include medication and treatment when indicated.
3
Sign each note
The heading says Sign all notes. Each row has a Signatures column.
4
Identify the patient and sponsor
For typed or written entries, the form says to give the name (last, first, middle), ID number (SSN or other), sex (male or female), date of birth and rank/grade, plus the sponsor details.
5
Add the facility details
Fill in the department/service, the hospital or medical facility, where records are maintained, and the register and ward numbers.
6
Continue on the back
The front says to continue on the reverse side. Enter the last name, first name, middle initial and ID number at the top of the back.

The form prints short directions in its headings. 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 510 (Rev. 5/2025), and the top of the form says the previous edition is NOT usable.

Prescribing rule and copies

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

Who fills out SF 510?

The person signing each note
The heading says Sign all notes, and each row has a Signatures column.
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 asks for the name, ID number (SSN or other), 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 name a role for the person writing the notes. Its blocks name these people and places.

Official sources and the blank

Official GSA form page
The agency’s own page for Form SF510.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form SF510

Who prescribes SF 510?

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

What goes in the Observations column?

The column heading says to include medication and treatment when indicated.

Who signs SF 510?

The heading says Sign all notes, and each row has a Signatures column. The form does not name a role.

Can an older edition of SF 510 be used?

The Rev. 5/2025 edition says at the top that the previous edition is NOT usable.

Can SF 510 be copied locally?

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

Standard Form 510 (SF 510): Medical Record - Nursing Notes