What does this form do? DA Form 4254 is titled REQUEST FOR PRIVATE MEDICAL INFORMATION, and its job is to request for private medical information. Anyone sent to find "the 4254" is being sent here. Everything below expands on that one function.
Am I looking at the right edition? The copy here carries the date 02/01/2003 and the status ACTIVE. Forms in the DA series are identified by edition date rather than by revision number, so that date is what you compare against.
Who fills it out, and how long does it take? The individual named in the entries fills it, or a records clerk fills it on that person's behalf. Length is unknown page(s) with about unknown entry fields, which is the honest measure of the work involved. Who owns the form and when it is raised comes from TSG and AR 40-66 respectively.
Download the form
What can I download here? The formats available are PDF. Each one reproduces the identical official layout. What separates them is the method of entry, nothing on the page itself.
What is the difference between fillable and printable? A fillable pdf has live fields that accept typing and can be saved with your entries in place. A printable pdf is the same blank page with no live fields, meant to come out of a printer and be completed with a pen. Both print identically once filled.
What do I open a pdf with? Any current browser will display one, and any dedicated reader will do better. For fillable use the reader is the safer choice, because some browser viewers accept typing and then discard it when the tab closes. Test one field and one save before committing.
Is it free? Yes, entirely. No registration stands between you and the file, and what arrives is exactly what the publisher released.
Which entries come before the rest? The identifying ones at the head of the page: name, identification number, unit, date of preparation. Does it matter that they come first? Yes — everything downstream retrieves the record by those values, so they are worth getting right before you touch the substantive blocks.
What is the fastest way to fill the body? Tab from field to field. The order was set at build time and normally matches how the page reads, which is why tabbing catches boxes that clicking past would leave empty. And the boxes and buttons? Those take a click. Where only one option in a set can apply, choosing one deselects the other.
What happens if your answer is too long for the field? It prints cut off. A single-line field does not wrap, so text running past the edge stays readable on screen and then disappears at the margin on paper. What do you do instead? Move it to the remarks area or onto a continuation sheet. And a field that does not apply to you? Mark it as not applicable rather than leaving it blank — an empty box tells the reviewer nothing about whether you read the question.
Where does the signature belong in the sequence? At the very end, by hand or by an accepted electronic means. An unsigned form is a draft regardless of how full it is. Are countersignatures needed? Where the form provides for them — reviewing official, approving authority, witness — taken in printed order and dated on the day applied. What should you check before releasing it? Empty mandatory fields, digit transposition in identification numbers, day-month inversion in dates, and residue from an old copy used in place of a blank one.
What does the Privacy Act notice tell you? The legal authority behind the collection, what the information is for, the routine uses it may be put to, and whether disclosure is compulsory. When is the right moment to read it? Before completing the personal entries, at the point the statement appears. What follows from it? Your finished copy contains personal data, so store and send it the way your office handles that category.
Where does the finished form go? Wherever AR 40-66 says — to the office it names, along your unit administrative channel, or into the individual's own record, depending on why it was raised. Should you keep a copy? Yes, before it leaves your hands. How long is it held? The records schedule for the series decides that, and local practice does not override it.
How do you find related forms? By series and number. Documents in the DA series sharing a proponent or a prescribing directive are commonly used together, and a form cited on the face of another usually goes forward with it. When should you gather them? Before submission — continuation sheets, cover sheets and transmittal documents belong in the package from the start.
What causes a form to be superseded? A revision issued by the proponent, after which the previous edition date no longer matches the one in force. How do you check a copy you saved? Read the edition date on the page and hold it against the current edition. Must earlier submissions be redone? They must not — a completed record executed on a prior edition is unaffected.
Who publishes these files? This site does, as copies of published Department of the Army forms offered for download. Is there any official connection? None — the site is independent of the Department of the Army and issues nothing itself. Will a given office accept your document? That is not something anyone here can state, and none of this page is legal advice. Where do you take a specific question? To TSG, or to the administrative office that services your unit.
Questions and answers
- What is DA Form 4254?
- REQUEST FOR PRIVATE MEDICAL INFORMATION
- Which edition is current?
- 02/01/2003
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA