Standard Form 507 PDF Details

Are you familiar with Standard Form 507 - the document used to transfer ownership of an individual’s military service record? If not, don't worry – we’re here to help. In this blog post, we will break down the things you need to know about Standard Form 507 and how understanding it can be beneficial for servicemembers who want to access their records or transfer them over once they have completed a tour of duty. With our comprehensive guide on what Standard Form 50 7 is and how it works, you'll gain peace of mind knowing your service record is in good hands when transitioning back into civilian life. So let's get started!

QuestionAnswer
Form NameStandard Form 507
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform om 501, google army form sf 507, sf 507 blank, online version of word

Form Preview Example

507-109

NSN 7540-00-634-41 20

Report On

or

MEDICAL RECORD continuation of S.F.

(Strike out one line) (specify type of examination or data)

Date:Addendum to Medical History (SF 93)

Health History Questionsllnterval History

Please circle the correct response for each question

1.

Have you recently had any medical problems or symptoms that bother you?

Yes

No

 

2. Do any of the following diseases run in your family (parents, grandparents, or siblings)? Cancer, Diabetes, and heart

 

 

 

attacksoranginapriortoage55

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

 

3.

Do you have jobs or hobbies which involve exposure to chemicals, dust, or loud noises?

Yes

No

 

4.

Do you routinely forget to wear proper protective gear for sports or hobbies? (e.g. helmets, goggles, ear plugs, gloves,

 

 

 

etc

.Yes

No

 

5.

Do you routinely forget to fasten your seatbelt?

Yes

No

 

6.

Do you exercise less than 3 times per week (at least 20 minutes a session)?

Yes

No

 

7.

In the past year have you been counseled on the risks and prevention of sexually transmitted diseases?

Yes

No

.

8.

Do you currently (or within the past 2 years) use tobacco products?

Yes

No

 

9.

Do you have more than one alcoholic drink per day?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

 

10. Have you, or anyone you know, thought you should cut down on your drinking?

Yes

No

 

11. Do you take prescription medications, over the counter drugs, or nutritional supplements to include herbs?

Yes

No

 

12. Do you eat more than one serving of high fat or cholesterol (e.g. red meat, eggs, cheese, chocolate, fried foods, milk,

 

 

 

etc...

)p erday?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

 

13. Do you eat fewer than 5 servings of fruits or vegetables each day?

Yes

No

 

14. Do you feel significantly stressed by your job or life events?

Yes

No

 

15. Do you feel you have serious problems dealing with your spouse, parents, children, or friends?

Yes

No

 

16. In the past few months have you been bothered by feeling down, helpless, panicky, or anxious?

Yes

No

 

17. Have you ever had surgery to correct your vision?

Yes

No

 

18. Since your last exam dated

have you:

 

 

 

 

a. Hadanybrokenbones?

Yes

No

 

 

b. Had any allergic reactions to food or medications?

Yes

No

 

 

c. Been hospitalizedfor at least 24 hours or more?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

 

 

d. Had any outpatient surgical procedures done (wisdom teeth, tonsillectomy, cyst removal)?

Yes

No

 

 

e. Been diagnosed with any medical condition that requires any special or continuous treatment?

 

 

 

 

Please explain all "yes" answers (diagnosis, date, cause, treatment):

Yes

No

 

f.Other than the items listed above, please list any other medical treatment or evaluation since your last examination.

19.To the best of my knowledge, NO INO OTHER significant medical or surgical history has occured since my last examination.

Patient Signature:

Examinee denies and medical record review reveals no other significant medical history since last exam dated

Physicians / Sr. Medical

Technician Signature:

(continue on reverse side)

PATIENT'S IDENTIFICATION (For typed or written entries g qEGISTER NO.

WARD NO.

Name-last, first, middle; grade; rank; rate; hospital orTmedical facility)

 

Name

 

REPORT ON

OR CONTINUATION OF

SSAN

 

 

 

 

Rank1Grade

Sex

DOB

Medical Record

Unit

 

 

STANDARD FORM 507 (08-01)

 

 

 

Prescribed by GSAICIMR, FlRMR (41-CFR) 201-9.202-1

 

 

 

(Computer generated by Pimr)

Procedures for Completing the SF507

PLEASE READ, DO NOT ANSWER ON THIS FORM

Dear 157th ARW Member,

Since the implementation of the PHA process and SF 507 we have noticed that required medical information has been left off the SF 507. In an effort to ensure that the SF 507 is completed accurately and with the appropriate information, we have developed this form to help you complete the SF 507. Please use it as you complete your SF 507. If you have any questions or concerns regarding this matter, please feel free to contact the Medical Group at X2340. Thank you for your help and cooperation

1.When you answer with a positive response (yes) to any question on the SF507 you are required to supply the appropriate information listed in the action section for each question.

2.Please explain all positive response (yes) answers on the back of the SF507, by placing the question number in front of each explanation.

 

 

QUESTION

IF YES:

ACTION

 

 

 

 

 

 

 

1

Have you recently had any medical problem or symptoms that bother

State medical problem and symptoms.

 

 

 

you?

 

 

 

 

 

 

 

 

 

2

Do any of the following diseases run in your family? Cancer,

List the disease and state the relationship of

 

 

 

Diabetes, and heart attacks or angina prior to age 55.

the person who has the disease to you.

 

 

 

 

 

 

 

3

Do you have job or hobbies, which involve exposure to chemicals,

List the job/hobbies also list what you are

 

 

 

dust, or loud noise?

exposed to.

 

 

 

 

 

 

 

 

4

Do you routinely forget to wear proper protective gear for sports or

List the names of sports/ hobbies.

 

 

 

hobbies?

 

 

 

 

 

 

 

 

 

 

5

Do you routinely forget to fasten your seatbelt?

Yes or No answer

 

 

 

 

 

 

 

 

 

6

Do you exercise less than 3 times per week? ( at least 20 minutes a

Yes or No answer

 

 

 

 

session)

 

 

 

 

 

 

 

 

 

7

In the past year have you been counseled on the risks and

State if counseling was a preventive health/

 

 

 

prevention of sexually transmitted diseases?

pre-deployment briefing or a follow up to

 

 

 

 

treatment.

 

 

 

8

Do you currently (or within the past 2 years) use tobacco products?

State the type of tobacco product you use; the

 

 

 

 

amount per day you use, and how long you

 

 

 

 

have been using.

 

 

 

 

 

 

 

 

9

Do you have more than one alcoholic drink per day?

State how many alcoholic drinks you consume

 

 

 

 

per day.

 

 

 

 

 

 

 

 

 

10

Have you, or anyone you now, thought you should cut down on your

Briefly explain.

 

 

 

 

drinking?

 

 

 

 

 

 

 

 

 

11

Do you take prescription medication, over the counter drugs or

List the name of the medication/supplement

 

 

 

nutritional supplements to include herbs?

and what it is taken for. Give the amount taken

 

 

 

 

and how often taken.

 

 

 

 

 

 

 

 

 

12

Do you eat more than one serving of high fat or cholesterol per day?

Yes or No answer.

 

 

 

 

 

 

 

 

 

13

Do you eat fewer than 5 servings of fruits or vegetables each day?

Yes or No answer.

 

 

 

 

 

 

 

 

 

14

Do you feel you have a high stress job or life style?

Briefly explain.

 

 

 

 

 

 

 

 

 

15

Do you feel you have serious problems dealing with your spouse,

Briefly explain.

 

 

 

 

parents, children or friends?

 

 

 

 

 

 

 

 

 

 

16

In the past few months have you been bothered by feeling down,

Briefly explain.

 

 

 

 

helpless, panicky, or anxious?

 

 

 

 

 

 

 

 

 

17

Have you ever had surgery to correct your vision?

State when and where surgery was done.

 

 

 

 

 

 

 

18

Since your last exam have you?

a. List bone broken and when

 

 

 

 

b. List allergy and reaction

 

 

 

 

c. List reason for hospitalization and when

 

 

 

 

d. list procedure and when.

 

 

 

 

e. List new medical condition and treatment.