What is DA Form 5441? It is the Department of the Army form titled EVALUATION OF CLINICAL PRIVILEGES - ANESTHESIA, and it exists so that you can evaluation of clinical privileges - anesthesia. That single line covers most of what people arrive looking for. The rest of this page fills in the details.
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 This version is superseded and stays here for reference and for records already filled out on it.
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
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.
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.
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.
Can a field hold a long answer? Not if it is sized for one line — there is no wrap, and the excess prints missing while remaining visible as you type. So where does the extra text belong? In the remarks area or a continuation sheet. Should you skip fields that are irrelevant to your case? No. Mark them accordingly, because an empty field reads as an oversight rather than an answer.
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.
What exactly is this site? A place to download reproductions of published Department of the Army documents. Is it part of the Department of the Army? No — it is independent, issues no forms of its own, and has no authority over any of them. Can it tell you whether your completed form will be accepted? It cannot, and nothing written here is legal advice. Who answers the real questions? TSG or the administrative office servicing your unit, on any question of entry, requirement or eligibility.
Questions and answers
- What is DA Form 5441?
- EVALUATION OF CLINICAL PRIVILEGES - ANESTHESIA
- 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