Parents and pregnancy
Expected date of confinement, the mother's health prior to pregnancy, abnormalities of previous pregnancies, gravida, para, stillbirths, abortions, living children, blood group and Rh, and past transfusion history.
SF535
Clinical Record - Newborn
- Agency
- GSA
- Revision
- Rev. October 1975
- Fillable fields
- 128
- Pages
- 2
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 535 (SF 535): Clinical Record - Newborn
Standard Form 535 (SF 535), Clinical Record - Newborn, is a two-sided clinical record dated OCTOBER 1975. Its footer says PRESCRIBED BY GSA/ICMR 41 CFR 201-45-505, and GSA hosts a copy in its forms library, where the authority is listed as GSA/ICMR (41 CFR) 201-45.505.
The front records the mother's and father's details, the pregnancy and prenatal course, analgesia and anesthesia, the delivery and the infant's condition at birth, with a signature line for the obstetrician. It then holds the initial physical examination, which the form says is to be completed within twenty-four hours of birth, signed by the physician. The back records the condition on discharge, discharge feeding, follow-up, a second physician signature and progress notes.
The PDF prints no other instructions. You can fill it out free in your browser on this page and download the result without an account.
What's on SF 535
Prenatal care and labor
Prenatal care by (name of physician), last menstrual period, serology, Vit. K, complications of delivery, prenatal course, analgesia and anesthesia.
Delivery and the infant at birth
Date and time of birth, method of delivery, length of first and second stage, condition at birth, character of cry, resuscitation, suction, oxygen, eye prophylaxis and remarks.
Initial physical examination
Boxes from general appearance, birth weight and measurements to spine, reflexes, Moro and joints, then abnormal findings, the physician's signature, date, sex and race.
Back: discharge and follow-up
Condition on discharge, discharge feeding (breast, breast and complement, or formula, with amount and number of feedings), and follow-up: nursing visit, private physician, clinic or social service referral.
Back: progress notes
A PROGRESS NOTES area at the foot of the back, headed Sign and date all notes.
How to fill out SF 535
- 1
Record the parents and pregnancy
Fill in the parents' names and ages, the register number, the pregnancy history, blood groups, prenatal care and prenatal course.
- 2
Record labor and delivery
The analgesia block asks whether scopolamine, barbiturate or opiate was used, with dosage and hours; then enter the delivery details and the infant's condition at birth.
- 3
Obstetrician signs
Summarize complications of pregnancy and birth and the nature of therapy under remarks, then the obstetrician signs and dates.
- 4
Complete the first exam
The form says the initial physical examination is to be completed within twenty-four hours of birth, and to use the progress sheet for abnormalities, description and elaboration.
- 5
Record the discharge
On the back, describe the condition on discharge, check the discharge feeding and follow-up, and the physician signs with the date and weight on discharge.
- 6
Keep progress notes
Add progress notes at the foot of the back. The heading says to sign and date all notes.
These steps follow the order of the blocks on the two pages.
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Where it goes and what the form says
Where it goes
The PDF prints no filing address. It is labeled Clinical Record, and the identification block names the hospital or medical facility.
Time stated on the form
The initial physical examination is headed To be completed within twenty-four hours of birth.
Prescribing note
The footer reads PRESCRIBED BY GSA/ICMR 41 CFR 201-45-505, OCTOBER 1975. GSA's page lists the authority as GSA/ICMR (41 CFR) 201-45.505.
Instructions and privacy
Apart from the notes printed in its blocks, the PDF prints no instructions, Privacy Act statement or burden estimate.
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Who fills out SF 535?
The form prints no general instructions. Its signature lines and blocks show who signs and whose record it is.
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Questions about Form SF535
Who issues SF 535?
The footer says PRESCRIBED BY GSA/ICMR 41 CFR 201-45-505 and dates the form OCTOBER 1975. GSA hosts a copy in its forms library.
When is the initial physical examination completed?
The form says it is to be completed within twenty-four hours of birth, and to use the progress sheet for abnormalities, description and elaboration.
Who signs SF 535?
The obstetrician signs after the pregnancy and birth section, and a physician signs after the initial physical examination and again at discharge. Progress notes are signed and dated as well.
What does the back of SF 535 cover?
Condition on discharge, discharge feeding, follow-up such as a nursing visit or a clinic or social service referral, the date and weight on discharge, and progress notes.
Do the parents sign SF 535?
No. The mother's and father's names and ages are recorded at the top, but the only signature lines are for the obstetrician and the physician.