The reason DA Form 4254 looks the way it does is that a file has to speak for itself. Officially REQUEST FOR PRIVATE MEDICAL INFORMATION, it serves to request for private medical information, and the record it produces outlasts the people and the circumstances behind it. Edition 02/01/2003, status ACTIVE, is the version published here: unknown page(s), close to unknown fields, each one present because some later reader will need that fact without being able to ask for it.
Behind any Army form sit two separate decisions. What the document asks is settled by TSG, which maintains and revises it. Whether you raise it, and where it goes once signed, is settled by AR 40-66. That division is the reason a form can outlive several changes in the process it serves.
Retrieval governs the order of entry. The head of the form takes name, identification number, unit and date, and those values become the handles by which the record is found later — the substantive blocks are never searched on. This is why the spelling must match official records exactly rather than approximately.
Tab order is not a convenience feature; it was fixed when the form was built and generally traces the page, so following it produces the sequence the designer intended and leaves fewer gaps than a mouse. Exclusive option groups clear the previous selection because the record is not permitted to hold two contradictory answers. Single-line fields do not wrap for the same reason the layout is fixed: the printed page has to fall in known positions, so text past the field width is cut at the margin even though the screen still shows it whole. Overflow belongs in remarks or on a continuation, where there is room designed for it. And an inapplicable field is marked rather than skipped, since a blank tells a later reader nothing about whether the question was considered.
The signature is the point at which entries become an assertion someone stands behind, so it follows everything else and its absence leaves a draft. Countersignatures by reviewing, approving or witnessing officials each carry their own weight and are dated at signing, which is how the file preserves the order of responsibility. Seen that way, the familiar errors are not clerical trivia: an unanswered mandatory field, digits transposed in an identification number, day and month reversed, and residue from a reused file each put something false or unresolved into a document that will be relied upon.
Behind the Privacy Act statement is a requirement that anyone asked for personal data be told, in advance, under what authority it is sought, for what purpose, who else routinely sees it, and whether refusal is possible. Reading it after completing the fields defeats its function. And the completed form is itself a personal record from that point on, subject to the handling rules such records carry.
Download the form
Formats exist because completion happens under different conditions, not because anyone wanted variety. The published set is PDF. A fillable pdf carries live entry objects, so typed text lands in fixed positions and stays legible whoever reads it later. A printable pdf drops those objects and leaves the page as an image, which is what an office needs where a screen is unavailable and a pen is not. The document itself is unchanged between them; what differs is the circumstance each anticipates.
Where a file opens matters more than it appears to. A browser will display a pdf, but browser viewers were built to read documents, and some accept keystrokes into fields they never intended to store — the entries are gone at tab close, without warning, because saving was never part of what that viewer does. A dedicated reader is built around the file's own structure and keeps what you enter.
There is no charge and no sign-up. Published documents are distributed as published, without modification.
The routing in AR 40-66 decides where the document goes — a named office, the administrative channel, or the individual's file — and the records schedule for the series decides how long it stays. Neither is a local judgement, because a record system loses its meaning if each office keeps things for its own preferred interval. Copy the form before submitting it.
Related documents are located by series and number, and the relation is rarely accidental — forms under one proponent or one directive tend to serve steps of a single procedure. Anything the DA series form names on its face normally travels with it, as do the continuations, covers and transmittals the process generates. Assembling them together is what makes the submission a complete account.
Editions change because the process changes, and the printed edition date is the only marker of which version a page belongs to. A copy saved locally cannot know it has been superseded, so the date on it is compared against the edition in force before reuse. Records already executed under an earlier edition are left alone — a document is read under the terms it was made, and reopening completed files to match a later form would falsify the account.
One boundary should be stated clearly. What is distributed here are copies of published Department of the Army forms; the site is independent, issues nothing of its own, and holds no position in the system it describes. Proponency, prescribing directives and retention schedules operate without reference to it. Consequently nothing here is legal advice and no assurance about acceptance is possible. Questions about a particular entry, a requirement or eligibility belong with TSG or your servicing administrative office.
Questions and answers
- What is DA Form 4254?
- REQUEST FOR PRIVATE MEDICAL INFORMATION
- Which edition is current?
- 02/01/2003
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA