Which form is this? DA Form 5441-41, official title EVALUATION OF CLINICAL PRIVILEGES - PHYSICAL MEDICINE AND REHABILITATION, used to evaluation of clinical privileges - physical medicine and rehabilitation. That is the whole answer in one sentence. What follows explains the version, the file and the entries.
Which edition is on this page? The one dated 02/01/2004, status ACTIVE. On army forms the edition date is the version, printed on the page itself so any copy can be checked. Be aware that a more recent edition has since been issued. This version is superseded and stays here for reference and for records already filled out on it.
Do I fill this in myself? Usually yes, unless an administrative office keeps the record for you, in which case they enter what you supply. The form itself belongs to TSG and is prescribed by AR 40-68. It runs to 2 page(s) and about 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.
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.
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.
What goes in first? The heading block — your name exactly as official records show it, then identification number, then organisation, then the date you prepared the form. Is the order important? It is, because those four entries become the index for the finished record, and an error there is the one mistake that hides the document from everyone looking for it.
How should you work through the entry fields? With the tab key. It follows the order the form was constructed in, which is usually the order the page reads, so nothing gets passed over. Do check boxes work the same way? They are clicked rather than tabbed into. In an exclusive group, a second click elsewhere clears your first choice, as intended.
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.
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.
What happens after signing? The form is routed as the prescribing directive requires: to a named office, through the unit administrative channel, or into the personal file. Do you get the original back? No, so make a copy first. Who sets the retention period? The applicable records schedule, not the office holding the document.
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.
Why do editions change? Because the proponent revises the content, and the edition date printed on the page marks the result. How do you tell whether a stored copy is still current? Compare its printed date against the edition in force before you use it again. Does a new edition invalidate what you already filed? No. Records executed under a superseded edition stand as they are.
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 5441-41?
- EVALUATION OF CLINICAL PRIVILEGES - PHYSICAL MEDICINE AND REHABILITATION
- 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
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)