What is DA Form 5441-10? It is the Department of the Army form titled EVALUATION OF CLINICAL PRIVILEGES-PSYCHIATRY, and it exists so that you can evaluation of clinical privileges-psychiatry. That single line covers most of what people arrive looking for. The rest of this page fills in the details.
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 is responsible for this document? TSG maintains it, and AR 40-68 prescribes when it is used and where it goes. Completion falls to the person the entries describe or to the administrative staff holding the file. As for effort: 2 page(s), roughly unknown fields.
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.
Should I take the fillable pdf or the printable one? Take the fillable version if you will type, since its entry areas respond to the keyboard and hold what you enter. Take the printable version if you will write by hand — it is the same blank form as a flat page image. The finished result looks the same either way.
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. What opens an xfdl file? Only the IBM Lotus Forms Viewer. The format is IBM Lotus Forms, carried by several Army systems, and no pdf reader or word processor will touch it.
Is it free? Yes, entirely. No registration stands between you and the file, and what arrives is exactly what the publisher released.
Where do you start? At the top of the page, with the identifying entries: name as your official records spell it, identification number, unit or organisation, date of preparation. Why first? Because those entries are what the form is filed and searched under later, and a record indexed on a misspelled name is a record nobody retrieves.
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.
When do you sign? Last, after every other entry is settled. Until the signature is applied the document is a draft, however complete it looks. What if more than one signature is required? Reviewing official, approving authority and witness sign in the order the blocks print, and each dates the form on the day of signing rather than the day it was prepared. What goes wrong most often? Mandatory fields left empty, transposed digits in identification numbers, dates with day and month reversed, and old entries surviving in a working copy that was reused instead of a fresh blank form.
Why does the form carry a Privacy Act statement? Because personal information is being collected, and the statement declares the authority, the purpose, who else routinely sees the data, and whether answering is required or optional. Is it worth reading? Read it before you fill the fields it governs, not after. Does it change how you keep the file? It should — a filled copy is a personal record and gets the handling such records receive.
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.
Which other forms travel with this one? Those found by series and number: DA series documents sharing a proponent or a governing directive are frequently needed in combination, and a form referenced on the face of another generally accompanies it. Do you assemble them before or after sending? Before. Continuation sheets, cover sheets and transmittals are part of the same package.
When is an edition replaced? When the proponent revises the form and publishes a new edition date. What should you do with a copy kept on your own machine? Check its date against the edition in force before reusing it. Does the change reach backwards? It does not; work already completed on an earlier edition remains valid as filed.
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 5441-10?
- EVALUATION OF CLINICAL PRIVILEGES-PSYCHIATRY
- 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,