SF603

Medical Record - Dental

Agency
GSA
Revision
Rev. 10/1975
Fillable fields
222
Pages
2
Official source
GSA form page
Checked
October 20, 2026
Fill SF603 online
Page 1 of form SF603

Standard Form 603 (SF 603): Health Record - Dental

Standard Form 603 (SF 603), Health Record - Dental, is a two-sided dental record. Its footer reads General Services Administration and SF Form 603 (Rev. 10/75), and GSA hosts a copy in its forms library. GSA's page lists it as Medical Record - Dental, while the form itself is headed Health Record, Dental.

The front holds Section I, the dental examination, with two tooth charts numbered 1 to 32, one for missing teeth and existing restorations and one for diseases, abnormalities and x-rays, each with a line for the signature of the dentist completing it. Section II holds the patient data. The back holds Section III, the attendance record, with charts for restorations and treatments completed during service and for subsequent diseases and abnormalities, and a table of services rendered.

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Top of page 1 of Standard Form 603 (SF 603): Health Record - Dental, as printed by GSA

What's on SF 603

Items 1 to 3: purpose, type and class

Purpose of examination (initial, separation or other), type of exam (1 to 4) and dental classification (1 to 5).

Item 4: missing teeth and existing restoration

A tooth chart numbered 1 to 32 and marked right and left, with remarks, place of examination, date and the dentist's signature.

Item 5: diseases, abnormalities and x-rays

A second chart with calculus, periodontoclasia, stomatitis, dentures needed, abnormalities of occlusion and the x-rays used: full mouth periapical, posterior bite-wings or other.

Section II: patient data

Items 6 to 14, from sex and race to name, date of birth (day-month-year) and identification number.

Items 15 and 16: charts on the back

Restorations and treatments (completed during service) and subsequent diseases and abnormalities, each with a tooth chart and a remarks box.

Item 17: services rendered

A ruled table with date, diagnosis and treatment, class, operator and dental facility, and initials, with the patient's name printed along the edge.

How to complete SF 603

  1. 1

    Mark the exam details

    Check the purpose of the examination in item 1, the type of exam in item 2 and the dental classification in item 3.

  2. 2

    Chart the teeth and sign

    Mark missing teeth and existing restorations on the item 4 chart, add remarks, and enter the place, date and dentist's signature.

  3. 3

    Record diseases and x-rays

    Complete item 5, including dentures needed after indicated extractions and the x-rays used, then the date, place and dentist's signature.

  4. 4

    Fill in the patient data

    Complete items 6 to 14 in Section II. Item 13 asks for the date of birth as day-month-year.

  5. 5

    Log each visit on the back

    Mark the charts in items 15 and 16 and add a row to item 17 for each service, with the operator and dental facility and initials.

The form prints no instructions beyond its items. 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.

Continuation sheet

GSA also hosts SF 603A, Medical Record - Dental - Continuation, which prints the same Section III, Attendance Record, with items 15 to 17.

Edition

The footer reads SF Form 603 (Rev. 10/75). GSA's page lists the current revision date as 10/1975.

Related forms

Who uses SF 603?

  • Dentists completing the examination

    Items 4 and 5 each end with a place of examination, a date and a signature of the dentist completing this section.

  • Operators and dental facilities

    Each row of item 17, Services Rendered, records the date, diagnosis and treatment, class, operator and dental facility, and initials.

  • The patient

    Section II asks for sex, race, grade, rating or position, organization unit, component or branch, service department or agency, name, date of birth and identification number.

  • Initial and separation exams

    Item 1 marks the purpose of the examination as initial, separation or other (specify).

The form does not say in words who fills it out. Its signature lines and blocks name these people.

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Questions about Form SF603

Who issues SF 603?

The footer prints General Services Administration. GSA hosts a copy in its forms library.

Is SF 603 called Health Record or Medical Record?

The form itself is headed Health Record, Dental. GSA's page lists it as Medical Record - Dental.

How are the teeth numbered on SF 603?

Each chart numbers the teeth 1 to 16 on the upper row and 17 to 32 on the lower row, with RIGHT and LEFT printed at the ends.

Which x-rays can be marked on SF 603?

Item 5E, Indicate X-Rays Used in This Examination, has boxes for full mouth periapical, posterior bite-wings and other (specify).