First, confirm you are on the right form. DA Form 5441-33 carries the official title EVALUATION OF CLINICAL PRIVILEGES - UROLOGY, and you use it to evaluation of clinical privileges - urology. Second, check the edition: the copy offered here is dated 02/01/2004 and its publication status is ACTIVE. Third, size up the job — 2 page(s) and about unknown entry fields, so you can decide whether to fill it now or set aside time. One thing to settle first: a later edition has been issued. Reach for this one only when you are working with a record already executed on it.
Now decide who does the writing. Normally you enter your own particulars, then hand the sheet to the unit administrative office for review. If you work in that office, you enter what the individual brings you. From there the path is the same for everyone: TSG is responsible for the form, and AR 40-68 tells you what triggers it and where it ends up. Look at the directive first whenever your case departs from the ordinary.
Start at the top of the page and work down. The heading blocks come first: write your name as it appears on your official records, then your identification number, then your unit or organisation, then the date you are preparing the form. Do not skip ahead to the interesting parts and come back — these heading entries are how your form is found in the file afterwards, and a form filed under a misspelled name is a form nobody can locate.
In the body of the form, tab from field to field instead of clicking around. The tab order follows how the form was constructed, which keeps you from missing a box. For check boxes and option buttons, click them. If you find a set where the choices are exclusive, expect your new selection to clear the previous one. Keep an eye on long entries as you type: fields built for one line will not wrap, and what overflows the width will print truncated even though your screen shows all of it. At that point move the text into remarks or onto a continuation. And when something does not apply to you, say so in the field — write the entry that means "none" rather than leaving white space a reviewer has to interpret.
Leave the signature until everything else is done. Sign by hand or by an approved electronic means, and remember that a form without a signature is a draft, however complete the entries. Where a second and third signature are required — reviewing official, approving authority, witness — go in the order the blocks appear, and each signer dates the form on the day of signing. Then go back to the top and read what you wrote. Look first for a mandatory field you passed over, then for transposed digits in your identification number, then for a date with the day and month inverted. If you started from a file you had used before, look also for entries left from that earlier use; nothing removes them but you.
Read the Privacy Act statement when it appears on the page, before you fill in the personal details it covers. It sets out the authority for collecting the information, the purpose behind it, the routine uses it may be put to, and whether your disclosure is required or voluntary. Then keep in mind what you have created — a completed copy carries personal data, and you handle and store it under the rules that apply to such records.
Download the form
Then choose a file to download. What you will see offered is PDF, XFDL, and the only question you need to answer is whether you are typing or writing. Type, and you want the fillable pdf, where the entry areas respond to your keyboard. Write, and you want the printable pdf, which you print empty and complete with a pen. The layout does not change between them, so pick whichever fits how you plan to work today.
After you download, open the file the right way. Double-click a pdf and your browser may take it, which is fine for reading but risky for filling: some browser viewers show you the fields, let you type, and then lose the text when you close the tab. Save the file to your computer first, then open it in a full pdf reader, and check that your entries survive a save before you type the whole form. If you downloaded the xfdl file, do not try a pdf reader on it. That format is IBM Lotus Forms, and you need the Lotus Forms Viewer to open it at all.
One last point before you move on: every format is free. No registration stands between you and the file, and what you download is the published form, unaltered.
Now send it on. Follow the routing in the prescribing directive, which will point you to a named office, to your unit administrative channel, or to your own file. Take a copy before you release it. From there the record follows the retention schedule for the series, and neither you nor the receiving clerk shortens or extends that on local judgement.
If you find you need a second form to go with this one, look by series and number. Forms in the DA series that share a proponent or a prescribing directive are often used together, and any form named on the face of this one normally goes forward with it. Gather continuation sheets, cover sheets and transmittal documents before you submit, not after somebody asks for them.
The next time you open this form from your own files, check the edition date first. Revisions come from the proponent without warning to you, so the only reliable step is to hold your copy against the current edition before filling it in again. Records you already completed under a superseded edition stand, and you do not go back to rework them.
Read this before you go. The file you download is a reproduction of a published Department of the Army document, offered as it was published. We are an independent site with no connection to the Department of the Army and no authority to issue anything, and we make no statement about whether your completed form will be accepted anywhere. Treat what you read here as information, not legal advice. Take real questions — about an entry, a requirement, or your eligibility — to TSG or to your servicing administrative office.
Questions and answers
- What is DA Form 5441-33?
- EVALUATION OF CLINICAL PRIVILEGES - UROLOGY
- 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