Administrative documents are written for readers who were not present, and DA Form 5441-34 is no exception. Titled EVALUATION OF CLINICAL PRIVILEGES - BEHAVIORAL HEALTH PRACTITIONER, it is used to evaluation of clinical privileges - behavioral health practitioner — a transaction that means little in conversation and a great deal in a file. The published edition here carries the date 02/01/2004 and the status ACTIVE. Its 2 page(s) and roughly unknown fields are sized to what the record must prove years later, which is always more than the moment appears to need. A newer edition exists. This one is retained because the documents completed on it were completed under its terms and are read under them.
Two offices stand behind the form, and the distinction between them explains most of what follows. TSG is the proponent: it decides what the form asks and revises it when the underlying process changes. AR 40-68 is the prescribing authority: it decides when the form is raised at all and where the completed document travels. Content and occasion are separated deliberately, so that a change in procedure does not require redesigning the page.
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.
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.
Signing is the act that makes the document evidence, and until it happens the entries are only a proposal. Additional signatures — reviewer, approver, witness — each stand for a separate judgement, dated when applied so the record shows who accepted what and in what order. The common faults all damage that record in the same way: a blank mandatory field breaks the chain of required answers, swapped digits in an identification number detach the document from its subject, an inverted day and month misplaces it in time, and stale data from a reused copy states things nobody meant to state.
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.
Where the signed form goes is settled by AR 40-68 rather than by the office holding it — a named recipient, the unit administrative channel, or the individual's own file, depending on why it was raised. Retention likewise belongs to the records schedule for the series, which exists so documents are kept for as long as anyone might need them and no longer. Keep a copy before release; the original serves the file from then on, not you.
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.
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.
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 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)