To fill out DHA Form 229, the DHA Universal Protocol Checklist – Procedure Version, you document four safety stages in order: the pre-procedure verification, the site marking, the time-out performed immediately before the procedure starts, and the debrief before anyone leaves the room. Each stage has specific items the team must confirm and record on the checklist, and the form becomes part of the patient’s medical record in MHS GENESIS once signed.
One boundary worth setting first. Form 229 covers invasive procedures performed outside an operating room at a military treatment facility — bedside procedures, clinic interventions, any non-suite setting. Procedures inside the OR go on DHA Form 228 instead. The safety steps are substantively the same on both forms; the procedure version is formatted for settings without a full surgical team or OR infrastructure. If a single patient has concurrent or sequential procedures during one event, every procedure must be listed on the checklist.
Complete the Pre-Procedure Verification
The first section captures an interdisciplinary check that the right patient is about to receive the right procedure at the right site with everything on hand. For procedures outside the OR, a licensed staff member — someone holding a professional healthcare license — should complete this portion when available.
Start with identity. State the patient’s full name and date of birth verbally with the patient, or with the legally authorized representative, and then visually inspect the identification armband to confirm the information matches. Cross-check the identity against the signed consent form and all other relevant documents.
Before the patient is moved to the procedural area, confirm that each of the following is present and correctly matched to the patient, and record the confirmations on the form:
- Relevant documentation, including history and physical notes, progress notes, and any pre-anesthesia assessment.
- An accurate, complete informed consent signed by both the provider and the patient within the preceding 30 days.
- Correctly labeled laboratory and radiology results.
- Any required blood products, implants, devices, or special equipment.
Report any discrepancy immediately to the provider performing the procedure. The procedure does not move forward until every item checks out.
Record the Site Marking
The next section documents that the procedural site has been physically marked on the patient. The operating provider — the person privileged to perform the procedure and who will be present when it takes place — marks the site using at least their first and last initials. Residents in graduate medical education programs may mark the site if they are present and actively involved. Use an indelible marker that stays visible after skin preparation and draping. If prep removes the mark, the provider re-marks the site before the time-out.
Whenever possible, have the patient or the legally authorized representative verbally confirm the procedure and the site to be marked. Marking happens before the patient is moved to the procedural area, or, if the procedure takes place in a clinic office or similar non-suite setting, before the time-out begins.
Certain situations have their own marking rules:
- For a lateral organ approached through a midline incision or natural orifice, mark the entry site and indicate the laterality of the organ.
- For spinal procedures, mark the general spinal region on the skin and use intra-operative radiographic techniques to identify and mark the exact vertebral level.
- For eye procedures, mark the skin next to the appropriate eye.
If the patient refuses site marking, or if marking is technically or anatomically impossible, follow the facility’s written alternative process and document that on the checklist.
Document the Time-Out
The time-out is the final safety gate, and it happens immediately before the incision, insertion, or start of the procedure — not earlier. The operating provider leads it, and every team member who will be involved from the start actively participates. The procedure cannot begin until all questions or concerns raised during the time-out are resolved.
Record each of the following confirmations on Form 229:
- Correct patient, verified by checking the identification band against the informed consent.
- Correct consent, with the team agreeing that the form matches the planned procedure.
- Correct site, with the marked site identified and the provider’s initials visible, or an approved alternate marking in place.
- Patient position appropriate for the planned procedure.
- Relevant images and test results properly labeled and displayed.
- All necessary equipment, implants, and supplies available.
- Any required pre-procedure antibiotics or fluids administered.
- Safety precautions confirmed, including a fire risk assessment.
If the patient is undergoing multiple procedures during the same event, give each procedure its own time-out entry on the checklist.
Complete the Debrief
Before anyone leaves the room, the team conducts a debrief. The operating provider is responsible for making sure it happens, but any team member can initiate it. For procedures outside the OR, whoever is documenting the debrief records the results on Form 229. Capture the final procedure name, instrument and sponge counts, specimen labeling, any safety issues or equipment problems that arose, wound classification, recovery concerns, and disposition planning.
Sign and File the Completed Form
The finished checklist must be included in the patient’s medical record. Most providers authenticate it using a Common Access Card, which stores the PKI certificates that enable digital signatures on the document. If electronic signing is unavailable, sign physically and upload a scanned copy as the fallback. The completed form is stored within MHS GENESIS, the Military Health System’s electronic health record.
Accuracy matters beyond the clinical stakes. Falsifying any entry on the checklist, or any other official military document, falls under Article 107 of the Uniform Code of Military Justice, which makes it a criminal offense to sign a false official document or make a false official statement with intent to deceive. Punishment is determined by court-martial and can include confinement, reduction in rank, or separation from service.
Where to Get the Form
DHA Form 229 is hosted on the DHA Forms Management page within the Inside DHA portal, which requires Common Access Card authentication. The public-facing Health.mil forms page directs users to that same CAC-restricted repository. If you work at a military treatment facility, you’ll typically reach the form through your facility’s internal network or through a link embedded in the electronic health record workflow. There is no publicly downloadable version available without CAC credentials.