This Anesthesia Record was developed for the Department of Defense / USAF as a replacement for the DoD Standard Form 517.  I was active in this project for 5 years.   It is available to all medical treatment facilities, military or civilian.   It incorporates the latest JCAHO and coding recommendations.  It has been published in a book on health information management and a legal journal, and has been praised by JCAHO officials.   There are three files for download.  The USAF Anesthesia Record is for general use.   The USAF WHMC Anesthesia Record is a record designed for use at Wilford Hall Medical Center.   In includes a continuation sheet, and also an anesthesia OB record.   The third form is a trauma anesthesia record with continuation record that is used at the Air Force Theater Hospital in Iraq.   NOTE: The USAF and USAF WHMC anesthesia record has just undergone several revisions in March 2005 based on many suggestions from other Air Force anesthesia providers.   This web page was last updated October 2006.

The record is provided in MS Excel 2003 or PDF.  The Excel format can be used to print and reproduce the record.   In addition, the form description and number can be added to the bottom.

Different printers have different characteristics, mainly, the "drivers" and the printing margins.  For example, a single page may print onto two sheets instead of one.  The record was developed using the HP Laser Jet 1200.  In the Excel Print Preview Page Set-Up, use the following settings: Portrait, scaling to 54% normal size; Margins: Top 0.25-0.5, Bottom 0, Left 0.2, Right 0.2, and center on page horizontally.   There is no header or footer.   However, how it prints will depend on the outer edge printable margins of the printer.  The Page Set-up may need to be adjusted.  It is preferable to adjust so there is little margin at bottom, but larger margin on top to allow for hole punches.   If you need help, please contact Tom Evans CRNA.   If necessary, I can send you a hard copy of the form.

Anesthesia Record in MS Excel format for formatting and reproduction / printing.

USAF Anesthesia Record

Zip file USAF Anesthesia Record

Trauma Anesthesia Record

Zip file Trauma Anesthesia Record

USAF WHMC Anesthesia Record

Zip file USAF WHMC Anesthesia Record

Zip file PDF USAF WHMC Anesthesia Record

USAF Anesthesia Record 2004 - before update.

USAF Anesthesia Record 2004

Zip file USAF Anesthesia Record 2004

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