SF516

Medical Record - Operation Report

Agency
GSA
Revision
Rev. 5/1983
Fillable fields
26
Pages
1
Official source
GSA form page
Checked
October 20, 2026
Fill SF516 online
Page 1 of form SF516

Standard Form 516 (SF 516): Operation Report

Standard Form 516 (SF 516), Operation Report, is a one-page medical record printed as STANDARD FORM 516 (REV. 5-83). Its footer says Prescribed by GSA/ICMR FIRMR (41 CFR) 201-45.505, and GSA hosts a copy in its forms library, where it is listed as Medical Record - Operation Report.

The form records the preoperative diagnosis, the surgical team (surgeon, first and second assistants, anesthetist, circulating nurse and scrub nurse), the anesthetic, start and end times, the operative diagnoses, drains, the sponge count, material forwarded to the laboratory, the operation performed and a description of it, prosthetic devices by lot number and the date of operation. The surgeon signs and dates it, and the last row identifies the patient.

The top of the form prints NSN 7540-00-634-4156. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of Standard Form 516 (SF 516): Operation Report, as printed by GSA

What's on SF 516

Preoperative diagnosis

An open area at the top of the form for the diagnosis before the operation.

Team and times

Surgeon, first assistant, second assistant, anesthetist, anesthetic, circulating nurse and scrub nurse, with TIME BEGAN, TIME ENDED, TIME OPERATION BEGAN and TIME OPERATION COMPLETED.

Diagnoses, drains and sponge count

OPERATIVE DIAGNOSES, DRAINS (Kind and number), SPONGE COUNT VERIFIED and MATERIAL FORWARDED TO LABORATORY FOR EXAMINATION.

Operation and description

OPERATION PERFORMED, then DESCRIPTION OF OPERATION (Type(s) of suture used, gross findings, etc.), PROSTHETIC DEVICES (Lot no.) and DATE OF OPERATION.

Signature and identification

SIGNATURE OF SURGEON and DATE, then PATIENT'S IDENTIFICATION, REGISTER/I.D. NO. and WARD NO.

The single page runs from the preoperative diagnosis at the top to the surgeon's signature and the patient identification at the bottom.

How to fill out SF 516

  1. 1

    Identify the patient

    For typed or written entries, give the patient's name (last, first, middle), grade, date and hospital or medical facility, plus the register or I.D. number and ward number.

  2. 2

    Record the diagnosis and team

    Enter the preoperative diagnosis and the names of the surgeon, assistants, anesthetist and nurses, and the anesthetic used.

  3. 3

    Enter the times

    Fill in time began and time ended beside the anesthetic, and the times the operation began and was completed.

  4. 4

    Note diagnoses, drains and sponges

    Write the operative diagnoses, the kind and number of drains, the sponge count verification and any material forwarded to the laboratory.

  5. 5

    Describe the operation

    Enter the operation performed, a description including the types of suture used and gross findings, any prosthetic devices by lot number, and the date of operation.

  6. 6

    Surgeon signs and dates

    The form closes with SIGNATURE OF SURGEON and a DATE box.

The form prints no step-by-step instructions. These steps follow its blocks.

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Where it goes and what the form says

Where it goes

The PDF prints no filing address. It is labeled Medical Record.

Laboratory material

The form has a box for MATERIAL FORWARDED TO LABORATORY FOR EXAMINATION. It does not name a separate form for the laboratory.

Stock number

The top of the form prints NSN 7540-00-634-4156.

Prescribing note

The footer says Prescribed by GSA/ICMR FIRMR (41 CFR) 201-45.505.

Related forms

Who completes SF 516?

  • The surgeon

    The SURGEON box names the surgeon, and the form closes with SIGNATURE OF SURGEON and DATE.

  • The assistants

    Boxes for the FIRST ASSISTANT and the SECOND ASSISTANT sit beside the surgeon's name.

  • The anesthesia team

    The form names the ANESTHETIST and the ANESTHETIC, with TIME BEGAN and TIME ENDED boxes.

  • The nurses

    Boxes for the CIRCULATING NURSE and the SCRUB NURSE, next to the times the operation began and was completed.

  • The patient

    For typed or written entries, the patient is identified by name (last, first, middle), grade, date and hospital or medical facility, with a register or I.D. number and ward number.

The form names the members of the surgical team and has one signature line, for the surgeon. It does not say who fills in each block.

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Questions about Form SF516

Who issues SF 516?

The footer says Prescribed by GSA/ICMR FIRMR (41 CFR) 201-45.505. GSA hosts a copy in its forms library, printed as STANDARD FORM 516 (REV. 5-83).

Who signs SF 516?

The form has one signature line, SIGNATURE OF SURGEON, with a date box.

Which team members does SF 516 list?

Surgeon, first assistant, second assistant, anesthetist, circulating nurse and scrub nurse, plus the anesthetic used.

What does the description of operation include?

Its label says Type(s) of suture used, gross findings, etc. Beside it are boxes for prosthetic devices by lot number and the date of operation.

What times does SF 516 record?

Time began and time ended beside the anesthetic, and the time the operation began and the time it was completed.