SF536

Medical Record - Pediatric Nursing Notes

Agency
GSA
Revision
Rev. 2/1995
Fillable fields
483
Pages
2
Official source
GSA form page
Checked
October 20, 2026
Fill SF536 online
Page 1 of form SF536

Standard Form 536 (SF 536): Pediatric Nursing Notes

Standard Form 536 (SF 536), Pediatric Nursing Notes, is a two-sided medical record sheet printed as STANDARD FORM 536 (REV. 2-95). Its footer says Prescribed by GSA/ICMR FIRMR (41 CFR) 201-9.202-1, and the top is marked Authorized for Local Reproduction. GSA hosts a copy in its forms library, where it is listed as Medical Record - Pediatric Nursing Notes.

Each side is a ruled table with columns for the date and hour, temperature and weight, diet, amount taken, vomited, urine, stools, treatments and medications, and a wide nursing notes column. The front ends with the patient's identification, a register number and a ward number.

The PDF prints no instructions. 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 536 (SF 536): Pediatric Nursing Notes, as printed by GSA

What's on SF 536

Date, hour, temp and weight

The first two columns are DATE over HOUR and TEMP over WT.

Diet and amount taken

A DIET column and an AMT. TAKEN column.

Vomited, urine and stools

Three narrow columns headed VOMITED, URINE and STOOLS.

Treatments and nursing notes

A TREATMENTS, MEDICATIONS column and a wide NURSING NOTES column.

Identification and footer

The patient's identification, register and ward numbers, and the footer Pediatric Nursing Notes, Medical Record, STANDARD FORM 536 (REV. 2-95).

How to fill out SF 536

  1. 1

    Date and time each row

    Enter the date and hour, and the temperature or weight, in the first columns.

  2. 2

    Record diet and intake

    Fill in the diet and the amount taken.

  3. 3

    Record vomiting, urine and stools

    Use the VOMITED, URINE and STOOLS columns.

  4. 4

    Add treatments and notes

    Enter treatments and medications, then the nursing note for that row.

  5. 5

    Identify the patient

    Complete the patient's identification with the register and ward numbers at the foot of the front, and continue on the back as needed.

These steps follow the columns of the table, left to right.

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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, and the identification block names the hospital or medical facility.

Prescribing note

The footer says Prescribed by GSA/ICMR FIRMR (41 CFR) 201-9.202-1.

Copies

The top of the front says AUTHORIZED FOR LOCAL REPRODUCTION.

Instructions and privacy

The PDF prints no instructions, Privacy Act statement or burden estimate.

Related forms

Who fills out SF 536?

  • The person making entries

    Each row has a NURSING NOTES column. The form has no signature column and does not name who makes the entries.

  • The patient, as identified

    The patient does not sign. The identification block takes name (last, first, middle), ID no. (SSN or other), and hospital or medical facility.

  • The medical facility

    The form is labeled Medical Record and carries REGISTER NO. and WARD NO. boxes beside the patient's identification.

  • Continuing records

    The back repeats the same table under the footer STANDARD FORM 536 (REV. 2-95) BACK.

The form prints no instructions. Its columns and blocks show what is recorded and whose record it is.

Official sources and the blank

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Questions about Form SF536

Who issues SF 536?

The footer says Prescribed by GSA/ICMR FIRMR (41 CFR) 201-9.202-1. GSA hosts a copy in its forms library, printed as STANDARD FORM 536 (REV. 2-95).

What columns does SF 536 have?

Date and hour, temp and weight, diet, amount taken, vomited, urine, stools, treatments and medications, and nursing notes.

Does SF 536 have a signature column?

No. The table has no signature column, and the form does not say who makes the entries.

Does SF 536 come with instructions?

No. The PDF prints only the column headings, the identification block and the footer.

Can SF 536 be copied locally?

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