SF601

Immunization Record

Agency
GSA
Revision
Rev. October 1975
Fillable fields
186
Pages
2
Official source
GSA form page
Checked
October 20, 2026
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Page 1 of form SF601

Standard Form 601 (SF 601): Immunization Record

Standard Form 601 (SF 601), Immunization Record, is a two-sided health record sheet for vaccinations and sensitivity tests. Its footer reads Standard Form 601, October 1975 (Rev.), General Services Administration & Interagency Committee on Medical Records, and GSA hosts a copy in its forms library. The top of the form says all entries in ink to be made in block letter, and the back says the record is issued in accordance with Article 99, WHO Sanitary Regulation No.2.

The front has tables for vaccination against smallpox, yellow fever vaccine, typhoid vaccine, tetanus-diphtheria toxoids and cholera vaccine, followed by the patient's identification. The back has tables for oral poliovirus vaccine, influenza vaccine, other immunizations and sensitivity tests such as tuberculin, then a remarks block. Every row has a date and a physician's name.

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Top of page 1 of Standard Form 601 (SF 601): Immunization Record, as printed by GSA

What's on SF 601

Vaccination against smallpox

Six rows with date, origin, batch number, reaction, station and physician's name. The heading asks for the number of previous vaccination scars.

Yellow fever vaccine

Three rows with date, origin, batch number, station and physician's name.

Typhoid, tetanus-diphtheria and cholera

Typhoid vaccine and tetanus-diphtheria toxoids have six rows each with date, dose and physician's name. Cholera vaccine has nine rows with date and physician's name.

Oral poliovirus and influenza

On the back, four rows each with date, dose and physician's name.

Other immunizations and sensitivity tests

Eight rows for other immunizations, and five rows for sensitivity tests (Tuberculin, etc.) with date, type, dose, route, results and physician's name.

Patient's identification and remarks

The identification block sits at the bottom of the front and is to be mechanically imprinted, typed or printed. A remarks block closes the back.

How to complete SF 601

  1. 1

    Use ink and block letters

    The top of the form says all entries in ink to be made in block letter.

  2. 2

    Identify the patient and sponsor

    Mechanically imprint, type or print the patient's and the sponsor's details in the identification block.

  3. 3

    Enter each dose in its table

    Use the table for the vaccine given and fill in the date, dose or batch details asked for and the physician's name.

  4. 4

    Record sensitivity tests

    For a tuberculin or other sensitivity test, enter the date, type, dose, route, results and physician's name.

  5. 5

    Add remarks

    Use the remarks block on the back for anything the tables do not cover.

The form prints no instructions beyond its headings. These steps follow them.

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Records and what the form says

Where it goes

The PDF gives no filing address or routing instructions.

WHO regulation

The back of the form says this record is issued in accordance with Article 99, WHO Sanitary Regulation No.2.

Edition

The footer reads Standard Form 601, October 1975 (Rev.). GSA's page lists the current revision date as 10/1975.

Related forms

Who uses SF 601?

  • Physicians giving immunizations

    Every table has a Physician's Name column next to each dated entry.

  • Stations recording vaccine batches

    The smallpox and yellow fever rows also ask for the origin, batch number and station, and the smallpox rows add the reaction.

  • The patient

    The patient's identification asks for the name (last, first, middle initial), sex, age or year of birth, relationship to sponsor, component or status and department or service.

  • The sponsor

    The same block asks for the sponsor's name (last, first, middle initial), rank or grade, SSN or identification number and organization.

The form does not say in words who fills it out. Its tables and identification block name these people.

Official sources and the blank

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Questions about Form SF601

Who issues SF 601?

The footer names the General Services Administration & Interagency Committee on Medical Records. GSA hosts a copy in its forms library.

Which vaccines does SF 601 have tables for?

Smallpox, yellow fever, typhoid, tetanus-diphtheria toxoids, cholera, oral poliovirus and influenza, plus rows for other immunizations and for sensitivity tests such as tuberculin.

How should entries on SF 601 be written?

The form says all entries in ink to be made in block letter. The patient's identification is to be mechanically imprinted, typed or printed.

What does SF 601 ask for on a smallpox vaccination?

The date, origin, batch number, reaction, station and physician's name for each row. The heading also asks for the number of previous vaccination scars.