RIGHT SIDE OF FOLDER
Form Number
Form Title and Notes
SF 513/
Medical Record - Consultation Sheet/Referral for
DD Form 2161
Civilian Medical Care.
SF545
Laboratory Report Display.
SF 515
Medical Record - Tissue Examination.
SF 516
Medical Record - Operation Report.
SF 517
Clinical Record - Anesthesia.
SF 518
Medical Record - Blood or Blood Component Transfusion.
SF 519B
Radiologic Consultation Request/Report.
SF 520
Clinical Record - Electrocardiographic Record.
SF 522
Medical Record - Request for Administration of
Anesthesia and for Performance of Operations and
Other Procedures (See AR 40-3).
SF 523
Clinical Record Authorization for Autopsy.
SF 523A
Medical Record - Disposition of Body.
SF 523B
Medical Record - Authorization for Tissue Donation.
SF 524
SF 525
SF 526
Medical Record - Interstitial Intercavitary Therapy
SF 527
Medical Record - Group Muscle Strength, Joint
R.O.M. Girth and Length Measurements.
SF 528
Medical Record - Muscle Function by Nerve
Distribution: Face, Neck, and Upper Extremity.
SF 529
Medical Record - Muscle Function by Nerve
Distribution: Trunk and Lower Extremity.
SF 530
Clinical Record - Neurological Examination.
SF 531
Medical Record - Anatomical Figure.
SF 533
Medical Record - Prenatal and Pregnance (and
relate prenatal documents).
SF 534
Medical Record - Labor.
SF 536
Clinical Record - Pediatric Nursing Notes.
SF 537
Medical Record - Pediatric Graphic Chart.
SF 538
Clinical Record Pediatric.
SF 541
Medical Record - Gynecological Cytology.
SF 560
Medical Record - Electroencephalogram Request and History.
Table 1-1. Filing sequence for documents in ITR folder (continued).
MD0753
1-32