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Department of Defense form 1924. Official designation: DD Form 1924, Surgical Checklist, October 1993.. Purpose: Surgical Checklist. Current edition not stated, status not stated.
Issued under not stated, with not stated as proponent. A DD number marks a Department-wide instrument: the same blank form serves every military department and the defense agencies, rather than one service alone.
Users include uniformed members of any branch, DoD civilian employees, contractor personnel where authorized, and the administrative staff who process the completed record.
Submission follows the schedule set by not stated and by local implementing procedures. This page provides the blank form for download and general orientation only.
Available formats: PDF. The form runs 1 pages and contains approximately 58 fillable fields.
Pdf serves as the base format. In the fillable variant, each box is an interactive field that holds typed text inside the document. In the flat printable variant, no fields exist — the page prints as a blank to be completed by hand. Typed entries survive transmission; handwriting does not always survive scanning.
What the form asks for
- Patient's identification.
- Unit/Room/Bed.
- Clinical records. Initial or mark N/A if not applicable. SF 515 - Tissue examination.
- SF 516 - Operation report.
- SF 517 - Anesthesia.
- SF 518 - Blood transfusion: number of units.
- SF 518 - Blood transfusion.
- SF 522 - Operative permit (signed and witnessed).
- SF 509 - Progress note (contains physician's informed consent).
- Blood transfusion consent.
- Medication administration record.
- IV flow sheet.
- History and physical.
- SF 511 - T.P.R. graphic.
- Nurses notes.
- Doctor's orders.
- X-ray (only the required) reports.
- Required X-ray films.
- Laboratory reports (only the required) hematology.
- Required laboratory urine test reports.
- EKG.
- Initial or N/A.
- Other (specify), line 1.
- Other (specify), line 2.
The document is filled from the top down. Identification precedes substance, substance precedes certification. Fields lower on the page are commonly keyed to entries made above them.
Verify the edition date against not stated before entry. Department-level revisions replace the blank across every service simultaneously, so an old copy in a desk drawer may no longer correspond to current field numbering.
Field-level instructions appear on the form itself and in not stated. The directive is the controlling text.
Once executed, routing follows not stated and the submitting organization's own instruction. Keeping a copy is standard.
Associated forms are traced by number within the series. Because the DD sequence is common to all military departments, no service qualifier is needed to identify a referenced form.
A DD number and a DA number may appear in the same instruction without being related. DA forms belong to the Army alone; DD forms belong to the Department and are administered at Department level. The sequences are independent.
Editions change because the underlying directive changes, because collection requirements are revised, or because Privacy Act language is updated. Checking the edition date at the point of download is the practical response.
Scope of this page: distribution of a published form and description of its contents. It offers no legal guidance and no assurance regarding any particular submission. Direct procedural questions to not stated, to the servicing personnel office, or to the office designated in not stated.
Questions and answers
- What is DD Form 1924?
- DD Form 1924, Surgical Checklist, October 1993.
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?