Begin by matching the form to your task. DA Form 5441-42 is titled EVALUATION OF CLINICAL PRIVILEGES - CARDIOLOGY, and you reach for it when you need to evaluation of clinical privileges - cardiology. 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.
Next, find out whether you are the one who fills it. In most cases you complete the entries yourself, and an administrator in your unit reviews what you wrote before it moves on. If you are the administrator, you will be working from what the individual gives you. Either way, TSG owns the form and AR 40-68 tells you when to raise it and where it goes afterward, so read the directive first if your situation is not routine.
Work from the top down, one block at a time. First the name — copy it from your official records rather than writing it the way you usually do. Then the identification number, then the unit, then today's date. Fill these before anything else. When the form reaches a file cabinet or a database, these are the entries someone searches on, so get them right before you worry about the rest.
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.
You will find a Privacy Act statement on the form wherever personal information is collected. Read it at that point rather than skipping past it, because it tells you the authority for the collection, the purpose, the routine uses, and whether answering is mandatory. After you fill the form, remember that your copy contains personal data. Store it and transmit it as your office requires for records of that kind.
Download the form
Next comes the download itself. The formats available are PDF, XFDL, and you decide between them by asking how you will enter the information. If you plan to type, take the fillable pdf: the boxes accept keyboard input and you can save the result. If you plan to write by hand, take the printable pdf and run it through your printer while it is still blank. Both show the same published page, so the decision affects your method and nothing else.
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.
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.
Once you have signed, route the form. The prescribing directive names the destination: an office, your unit administrative channel, or your personal file, according to the case. Make yourself a copy first, because you will not get the original back. After that, retention is out of your hands — the applicable records schedule fixes how long the document is kept, whatever the practice in a particular office.
When another document has to travel with this one, find it by series and number. Forms in the DA series sharing a proponent or a governing directive are commonly used in combination, and anything cited on the face of your form generally goes with it. Assemble continuation sheets, covers and transmittals before you send the package rather than in response to a query.
Check the edition date again the next time you reach for this form. Editions change when the proponent revises the content, and a copy you saved months ago may no longer be current — compare the date printed on your file against the edition in force before you type anything into it. What you do not need to do is redo work already finished: a form you completed and submitted under an earlier edition stays as it is.
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 5441-42?
- EVALUATION OF CLINICAL PRIVILEGES - CARDIOLOGY
- 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