What does this form do? DA Form 5441-1 is titled EVALUATION OF CLINICAL PRIVILEGES-DENTISTRY, and its job is to evaluation of clinical privileges-dentistry. Anyone sent to find "the 5441-1" is being sent here. Everything below expands on that one function.
Is this the current version? The edition offered here is dated 02/01/2004, published with the status ACTIVE. That date is the version number of a military form; there is no other. And no, this is not the newest one. A later edition has been published, and this copy is kept only for reference and for records already completed on it.
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 1 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 40-68 respectively.
Download the form
What file types are offered? PDF, XFDL. The page image is the same in every one of them; only the way you complete it changes from format to format.
Fillable or printable — which do I want? Fillable, if there is a keyboard involved: the boxes are interactive objects that store text. Printable, if there is a pen involved: the boxes are just lines on paper. Nothing else distinguishes them.
Do I need special software? Not for reading — a pdf opens in the browser you already have. For filling, install a full pdf reader rather than trusting the in-browser viewer, which sometimes displays fields it cannot save. Type into one field, save, reopen and confirm the text survived. Why will my xfdl file not open? Because it is IBM Lotus Forms, not pdf. The Lotus Forms Viewer is the only application that reads it.
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.
Why does my text vanish when I print? Because one-line fields have no wrap, and anything past the field width is truncated on paper even though the screen shows all of it. Where should the overflow go? Into remarks, or onto a continuation. What about entries that do not apply? Enter the mark meaning "none". Blank space is ambiguous; a reviewer cannot tell an omission from a considered nil.
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 40-68 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 5441-1?
- EVALUATION OF CLINICAL PRIVILEGES-DENTISTRY
- Which edition is current?
- 02/01/2004
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA