Every entry on DA Form 5223-R exists because a record system needs it in writing. The form's official title is CHILD DEVELOPMENT SERVICES (CDS) CHILD HEALTH ASSESSMENT, and it is raised whenever an office must child development services (cds) child health assessment (lra) in a way that survives the departure of everyone involved. Memory does not transfer between assignments; a filed document does. The edition dated July 1989, status not stated, is what stands here, spread across 2 page(s) and about 200 fields — a count that reflects how much detail the receiving system requires, not how much the drafter wishes to give.
Behind any Army form sit two separate decisions. What the document asks is settled by ACSIM, which maintains and revises it. Whether you raise it, and where it goes once signed, is settled by AR 608-10. That division is the reason a form can outlive several changes in the process it serves.
Identification precedes substance for a structural reason. Name, identification number, organisation and date of preparation are how the finished document is located in a file or a database; the body of the form is what someone reads after the search has succeeded. Spell the name as official records spell it, since the search runs against those records and not against habit.
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.
A signature is what converts entries into a record, which is why it comes last and why an unsigned form remains a draft however complete it looks. Where a reviewing official, an approving authority or a witness also signs, each adds a distinct attestation, and each dates the day of signing rather than the day of preparation — the dates trace the sequence of responsibility. The recurring defects are worth knowing precisely because they defeat that purpose: an empty mandatory field leaves an obligation unmet, transposed identification digits attach the record to nobody, a date with day and month reversed puts events in the wrong order, and entries left in a reused working copy assert facts nobody intended.
Personal information may not be gathered silently, and the Privacy Act statement is how that obligation is met on paper: it names the collection authority, the purpose, the routine uses and whether disclosure is mandatory. Because it exists to inform a decision, it belongs before the fields it covers rather than after them. A filled copy then holds personal data and is stored and transmitted under the corresponding safeguards.
Download the form
Formats exist because completion happens under different conditions, not because anyone wanted variety. The published set is PDF, XFDL. 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.
The choice of application decides whether your work survives. Browsers render pdfs as documents to be read; where a viewer shows fields without a mechanism to store them, typed text disappears when the tab closes, and nothing announces the loss. A full reader treats the file as a form and preserves entries on save. The xfdl format comes from IBM Lotus Forms, used across Army systems because of the routing and signature functions built into it, and it opens in the Lotus Forms Viewer alone.
No charge and no account apply: these are published documents, and access to them is not something a distributor is entitled to price.
What the form asks for
- ACTIVITY
- ADMINSTR
- ADMINSTR_1
- ADMINSTR_2
- ALLERGIES
- ASTHMA_N
- ASTHMA_Y
- AUDTPROB_N
- AUDTPROB_Y
- BEDWETS
- CHICKPOX_N
- CHICKPOX_Y
- CHILD_DOB
- CHILD_NAME
- COLDS
- COMENTS
- CONSTIP
- ContentArea1
- ContentArea2
- DATE_A
- DATE_B
- DIABETES_N
- DIABETES_Y
- DIARRHEA
The routing in AR 608-10 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.
Series and number are how the DA series signals which documents belong together, and the grouping follows real process boundaries: a shared proponent or directive usually means a shared purpose. A form cited on the face of another is part of that same transaction, and continuation sheets, covers and transmittals complete it.
Revision follows the process, which is why editions appear without a fixed interval, and the printed date rather than any version number identifies them. Nothing on a stored copy signals that it has aged; the check is manual. Work already completed under a superseded edition stands as filed, because the record was made under those terms and is properly interpreted under them.
A word on where this page sits. These are reproductions of published Department of the Army documents, made available by an independent site with no official role and no authority to issue forms. The structure described above — proponent, prescribing directive, records schedule — exists apart from this site entirely, which is why nothing written here is legal advice and why acceptance by any office is not something that can be promised. Put questions of entry, requirement or eligibility to ACSIM or to the administrative office servicing your unit.
Questions and answers
- What is DA Form 5223-R?
- CHILD DEVELOPMENT SERVICES (CDS) CHILD HEALTH ASSESSMENT
- Which edition is current?
- July 1989
- Who is responsible for this form?
- ACSIM
- In which formats can it be downloaded?
- PDF, XFDL