Begin by matching the form to your task. DA Form 5441-34 is titled EVALUATION OF CLINICAL PRIVILEGES - BEHAVIORAL HEALTH PRACTITIONER, and you reach for it when you need to evaluation of clinical privileges - behavioral health practitioner. Once that matches, check the date. The edition here is 02/01/2004, published with the status ACTIVE. After that, glance at the length: you will be working through 2 page(s) and somewhere near unknown fields. Check this before anything else — a more recent edition is out. Stay on this one only if the record you are handling was already completed on it.
Then work out your role. If the entries describe you, you fill them in and someone in the administrative section checks the result. If you handle records for others, you enter what they supply and pass the form along. In both cases the same two references govern you: TSG maintains the form, and AR 40-68 sets out the trigger for using it and the route it takes. Read that directive before you start when anything about your case is unusual.
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.
Once you reach the body of the form, move between fields with the tab key rather than the mouse; it follows the order the form was built in and you are less likely to skip a box. Click check boxes and option buttons directly. When you meet a group of options where only one can apply, notice that selecting a second one clears the first — that is intended, not a fault. Watch your longer answers as you type them. A single-line field does not wrap, so text that runs past the edge stays visible on screen and then prints cut off. When you see that happening, stop and move the text to the remarks area or a continuation instead of squeezing it in. If a field does not apply to you, mark it rather than leaving it empty; a blank space tells the reviewer nothing about whether you considered the question or missed it.
Sign at the end and not before. Use ink or the electronic method your office accepts; whatever the state of the entries, an unsigned form is still a draft. When a reviewer, approver or witness has to sign as well, collect those signatures in printed block order and make sure each one is dated the day it was applied, not the day you started. Then read the form through once from the beginning. Three faults account for most rejections: a required field left blank, an identification number with two digits swapped, and a date whose day and month are reversed. Add a fourth if you began from an old working copy — data left over from the last time will travel forward untouched.
At some point while filling the form you will meet a Privacy Act statement, and you should read it when you reach it rather than after you finish. It tells you who is authorised to collect the information, what it will be used for, who else may see it, and whether you are obliged to answer or may decline. Once you have entered your details, treat the file accordingly: it now holds personal information about you, so store it and send it the way your office handles 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.
Then take care with how you open what you downloaded. Your browser will happily display a pdf, and for reading that is enough — but for typing it is not, because some in-browser viewers accept keystrokes and then throw them away when the tab closes. Put the file somewhere on disk, open it in a proper reader, type into one field and save, and confirm the text is still there when you reopen. If you picked up the xfdl copy, get the IBM Lotus Forms Viewer before you go any further, because nothing else will open the file.
Finally, note what the download costs you: nothing. You do not create an account, you do not enter an email address, and the file you receive is the published document with nothing added to it.
With the form signed, send it where AR 40-68 tells you to send it — usually to the office it names, or through your unit administrative channel, or straight into your own record, depending on why you raised it. Keep a copy for yourself before it leaves your hands. How long the receiving office holds it is not your decision or theirs; the records schedule for the series settles that, and local habit does not override it.
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.
Before you reuse a saved copy, look at the edition date printed on it. The proponent revises the form from time to time, and your stored file will not tell you when that happens — you compare its date against the current edition yourself. If a revision has come out since you last filed one of these, leave the earlier submission alone; the change does not reach backwards.
Finally, know where you are. These are copies of published Department of the Army forms, made available for you to download. The site is independent, unconnected to the Department of the Army, and in no position to issue forms or to promise that any office will accept yours. None of this is legal advice. If a specific entry puzzles you, if you are unsure a requirement applies, or if eligibility is in question, put the question to TSG or to the administrative office serving your unit.
Questions and answers
- What is DA Form 5441-34?
- EVALUATION OF CLINICAL PRIVILEGES - BEHAVIORAL HEALTH PRACTITIONER
- 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)