What does this form do? DA Form 5441-5 is titled EVALUATION OF CLINICAL PRIVILEGES-OBSTETRICS AND GYNECOLOGY, and its job is to evaluation of clinical privileges-obstetrics and gynecology. Anyone sent to find "the 5441-5" is being sent here. Everything below expands on that one function.
Am I looking at the right edition? The copy here carries the date 02/01/2004 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. One correction: a newer edition now exists. This one is superseded and remains available only for reference and for files already executed on it.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: 4 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.
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. 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.
Do I have to sign up? No. Every format is free, no account is involved, and the file is distributed unmodified.
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.
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.
Is a signature really the last step? Yes, and without it you have a draft, not a form. Who else signs? Whoever the form calls for — reviewer, approver, witness — in printed block order, each dated as of the day they sign. Which errors cause the most returns? Blank mandatory fields lead, followed by identification numbers with two digits swapped, dates written day-for-month, and leftover data in a reused file that goes forward as though it were meant.
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.
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.
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 5441-5?
- EVALUATION OF CLINICAL PRIVILEGES-OBSTETRICS AND GYNECOLOGY
- 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,