Every entry on DA Form 5441-57 exists because a record system needs it in writing. The form's official title is EVALUATION OF CLINICAL PRIVILEGES - PSYCHIATRIC ADVANCED PRACTICE NURSE, and it is raised whenever an office must evaluation of clinical privileges - psychiatric advanced practice nurse 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.
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.
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.
The rules of entry all trace back to the page being fixed in advance. Tabbing follows the order built into the form, which usually matches how the page reads and misses less than clicking. An exclusive group discards the earlier selection because contradictory entries would make the record unusable. One-line fields have no wrap because print positions are predetermined, so an overlong entry displays fully and prints truncated. Longer text goes to the remarks area or a continuation, both provided for exactly that. Where nothing applies, the nil mark is entered — a blank leaves the reader unable to tell a considered answer from a skipped one.
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.
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.
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.
Forms cluster by series and number for the same reason files do: shared proponency and a shared prescribing directive usually mean a shared process. So a document in the DA series referenced on the face of another is generally part of the same transaction, and continuation sheets, cover sheets and transmittals belong to the package from the outset rather than arriving after a query.
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 5441-57?
- EVALUATION OF CLINICAL PRIVILEGES - PSYCHIATRIC ADVANCED PRACTICE NURSE
- 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),