Every entry on DA Form 5441-30 exists because a record system needs it in writing. The form's official title is EVALUATION OF CLINICAL PRIVILEGES - NEPHROLOGY, and it is raised whenever an office must evaluation of clinical privileges - nephrology in a way that survives the departure of everyone involved. Memory does not transfer between assignments; a filed document does. The edition dated 02/01/2004, status ACTIVE, is what stands here, spread across 2 page(s) and about unknown fields — a count that reflects how much detail the receiving system requires, not how much the drafter wishes to give. A later edition has since been published, which is why this one remains: records executed against it must still be readable in the terms they were written.
The form has an author and an occasion, held by different authorities. TSG owns the content and reshapes it when what is being recorded changes. AR 40-68 governs the event that calls for the form and the route the finished document takes afterwards. Keeping those two apart is what allows a procedure to be amended without the page being rebuilt each time.
The heading blocks come first because the record is retrieved by them, not read into. Name as official records spell it, identification number, unit, date of preparation — those four are the index, and everything below them is content that only surfaces once the index has done its work. A form filed under a name written casually is not lost in principle, only in practice, which amounts to the same thing.
Much of the form's behaviour follows from its being a fixed page. Tab order was set at build time along the reading sequence, which is why tabbing catches boxes a pointer passes over. Exclusive groups release one choice when another is made because a record cannot carry two answers to a single question. Single-line fields refuse to wrap because every entry must print where the layout expects it — text beyond the width is lost at the margin, visible on screen to the end. That is what remarks areas and continuation sheets are for. Marking a field that does not apply matters for a related reason: emptiness is ambiguous, and a reviewer reading the file later cannot distinguish an omission from a decision.
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
The published formats — PDF, XFDL — reflect the range of places a form gets filled in. Where there is a computer, the fillable pdf supplies live fields that keep entries positioned and readable. Where there is not, the printable pdf gives the identical page as flat artwork for pen entry. The distinction is one of setting rather than of authority; the page is the same document in both.
Software determines whether an entry lasts. A browser viewer is designed for reading, and several will take typed input into fields without any means of writing it back — the text is simply absent when you reopen. A standalone reader handles the form structure properly. The xfdl file is IBM Lotus Forms, carried in Army systems for the routing and signature support it provides, which is why the Lotus Forms Viewer is its only reader.
Downloads are free and unregistered. The material was published for general use, and the files are passed on unaltered.
The routing in AR 40-68 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.
An edition marks the form at a point in a process that keeps moving, and the date printed on the page is what distinguishes one from another. Since a saved file never announces its own obsolescence, compare its date against the current edition before using it again. Prior executions remain valid: the change applies forward, and a record is read against the edition it was written under.
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 TSG or to the administrative office servicing your unit.
Questions and answers
- What is DA Form 5441-30?
- EVALUATION OF CLINICAL PRIVILEGES - NEPHROLOGY
- 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)