SF Form 519B: Radiologic Consultation Request/Report (NOT LRA)

SF Form 519B: Radiologic Consultation Request/Report (NOT LRA) – The form, officially titled “Radiologic Consultation Request/Report (Radiology/Nuclear Medicine/Ultrasound/Computed Tomography Examinations),” carries the revision date August 1983 (SF 519-B, Rev. 8-83) and NSN 7540-01-165-7294. It is prescribed by the General Services Administration (GSA) under relevant federal regulations for medical record documentation.

What Is SF Form 519B Used For?

Healthcare providers (typically physicians or authorized clinicians) use SF 519B to:

  • Request specific imaging studies for patients.
  • Document the radiologist’s interpretation and findings once the examination is completed.
  • Ensure clear communication between the referring provider and the radiology department.

It serves as a key working document in radiology departments, often called the “X-ray request slip.” As procedures are performed, results are transcribed onto the form. Distribution typically includes:

  • Copy 1 → placed in the patient’s medical record.
  • Copy 2 → forwarded to the requesting physician.
  • Copy 3 → retained by the radiologic facility.

This form supports outpatient and inpatient medical records in military treatment facilities (MTFs), Department of Defense (DoD) settings, Veterans Affairs (VA) contexts, and other federal healthcare environments. It is referenced in Army Regulation 40-66 (Medical Record Administration), Air Force instructions, and DoD health record policies.

Note on “NOT LRA”: The designation “NOT LRA” (likely meaning “Not Locally Reproducible/Approved” or a similar administrative note) appears in some contexts, particularly Air Force or specific facility listings, to indicate the form is a controlled or centrally managed item rather than one that can be locally reproduced without authorization. This helps maintain standardization in official medical records.

Key Sections of SF Form 519B

The multi-part form includes fields such as:

  • Patient Identification: Name, register number, date of transaction, ward/clinic, pregnant (Yes/No).
  • Request Details: Date requested, telephone/page number, location of radiologic facility.
  • Examination Requested: Specific imaging modality and details (e.g., chest X-ray, CT abdomen, ultrasound).
  • Clinical History/Indication: Reason for the study and relevant patient history.
  • Radiologic Consultation/Report: Findings, impressions, and recommendations by the interpreting radiologist.
  • Signatures: Requesting provider and radiologist.

It includes a clear layout for both the request and the final report, ensuring all critical information is captured in one document.

How to Obtain and Use SF Form 519B

  • Official Source: Download the current PDF version from the GSA website: SF519B on GSA.gov.
  • Alternative Links (provided by user): physical.pdf and physical.epub — these appear hosted on Air Force e-Publishing and may contain related procedural guidance or the form itself in certain contexts.
  • U.S. Government departments and agencies can order physical copies through GSA Global Supply or GSA Advantage using a government purchase card or AAC.

Important: Always use the most current official version for compliance with medical record standards. Electronic health record (EHR) systems in military facilities (such as CHCS or AHLTA successors) often integrate similar data fields, but the paper form remains relevant for certain documentation, archiving, or specific scenarios.

Who Uses SF 519B?

  • Military Treatment Facilities (Army, Air Force, Navy, DHA).
  • Federal Healthcare Providers working with uniformed service members, retirees, and beneficiaries.
  • Radiology departments for standardizing consultation requests and reports.

It is distinct from related forms such as:

  • SF 519 or SF 519A (sometimes used for radiographic reports or single-exam variants).
  • SF 513 (general Medical Record—Consultation Sheet).
  • Various DD Forms for other medical documentation.

Best Practices for Completion

  1. Provide complete patient identification and clinical history to ensure accurate interpretation.
  2. Clearly specify the examination requested and any special instructions (e.g., contrast, urgency).
  3. Include pregnancy status when applicable for radiation safety.
  4. Ensure legible signatures and dates.
  5. Follow facility-specific policies for filing, distribution, and retention of radiology records (see AR 40-66 or AFI 44-102 for guidance).

In modern practice, many facilities have transitioned to fully electronic ordering and reporting within Picture Archiving and Communication Systems (PACS) and EHRs. However, SF 519B continues to play a role in standardized documentation, especially where paper records or hybrid systems are in use.

Download SF Form 519B

For the official blank form:

Disclaimer: This article is for informational purposes only and is based on publicly available government sources. Always consult your facility’s medical records administrator, compliance officer, or current DoD/DHA policy for specific usage instructions, as local procedures and electronic systems may vary. Forms and regulations can be updated; verify the latest version on GSA.gov or official e-publishing sites.

Keywords: SF 519B, SF Form 519B, Radiologic Consultation Request/Report, Standard Form 519B, military radiology form, SF 519-B download, DoD medical records, Air Force radiology forms.

Last updated based on sources current as of 2026. For the most accurate guidance, refer directly to GSA and DoD publications.