Administrative documents are written for readers who were not present, and DA Form 5441-40 is no exception. Titled EVALUATION OF CLINICAL PRIVILEGES - THERAPEUTIC RADIOLOGY, it is used to evaluation of clinical privileges - therapeutic radiology — 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 1 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.
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 40-68. 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.
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.
The Privacy Act statement is on the page because collecting personal information requires the collector to disclose the terms first — the authority relied on, the purpose, the routine uses, and whether an answer is required or may be withheld. That order is the point: the statement is read before the entries it governs, since consent given afterwards is not consent. Once completed, the copy is a personal record and carries the handling obligations that attach to one.
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.
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.
There is no charge and no sign-up. Published documents are distributed as published, without modification.
Disposition is prescribed, not chosen. AR 40-68 names the destination, whether that is a specific office, the unit administrative channel or the personal record, and the applicable records schedule governs how long it survives there. Both rules exist to keep the file consistent across offices with different habits. Take your copy before the document leaves, since it will not come back.
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.
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.
It is worth being plain about what this page is within all of the above. The files are reproductions of published Department of the Army documents, offered for download by a site with no official standing and no part in issuing anything. That matters because the machinery described here — proponency, prescribing directives, records schedules — runs entirely elsewhere. Nothing written here is legal advice, and no statement can be made about whether an office will accept a given document. TSG and the administrative office servicing your unit answer questions of entry, requirement and eligibility, and they are the ones positioned to.
Questions and answers
- What is DA Form 5441-40?
- EVALUATION OF CLINICAL PRIVILEGES - THERAPEUTIC RADIOLOGY
- 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,