Which form is this? DA Form 5441-55, official title EVALUATION OF CLINICAL PRIVILEGES - ORTHOPAEDICS, used to evaluation of clinical privileges - orthopaedics. That is the whole answer in one sentence. What follows explains the version, the file and the entries.
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 2 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
Which formats can I download? These: PDF. All of them carry the same published page — the difference is not what the form says but how you get words onto it.
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.
Which application should I use? Reading takes nothing beyond a browser. Filling takes a proper pdf reader, since browser viewers vary in whether they retain what you type — verify with a single field and a save before you fill the whole form.
Do I have to sign up? No. Every format is free, no account is involved, and the file is distributed unmodified.
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 do you move through the fields? By tab, not by mouse. The tab order was fixed when the form was built and generally follows the reading order of the page, so following it is the simplest way to avoid skipping a box. What about check boxes? Click them. If a group is exclusive, your new selection clears the old one — that is the design, not a malfunction.
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.
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.
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 5441-55?
- EVALUATION OF CLINICAL PRIVILEGES - ORTHOPAEDICS
- Which edition is current?
- 02/01/2004
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, PDF
Publisher notes
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA,