The reason DA Form 5569 looks the way it does is that a file has to speak for itself. Officially ISONIAZID (INH) CLINIC FLOW SHEET, it serves to isoniazid (inh) clinic flow sheet, and the record it produces outlasts the people and the circumstances behind it. Edition 02/01/2003, status ACTIVE, is the version published here: 1 page(s), close to 200 fields, each one present because some later reader will need that fact without being able to ask for it.
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 40-66 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.
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.
Where a file opens matters more than it appears to. A browser will display a pdf, but browser viewers were built to read documents, and some accept keystrokes into fields they never intended to store — the entries are gone at tab close, without warning, because saving was never part of what that viewer does. A dedicated reader is built around the file's own structure and keeps what you enter. The xfdl file belongs to a different lineage entirely: IBM Lotus Forms, adopted across Army systems for the routing and signature handling built into it. That is why only the Lotus Forms Viewer reads it.
There is no charge and no sign-up. Published documents are distributed as published, without modification.
What the form asks for
- ASSESM_A
- ASSESM_A_1
- ASSESM_B
- ASSESM_B_1
- ASSESM_C
- ASSESM_C_1
- ASSESM_D
- ASSESM_D_1
- ASSESM_E
- ASSESM_E_1
- ASSESM_F
- ASSESM_F_1
- ASSESM_G
- ASSESM_G_1
- ASSESM_H
- ASSESM_H_1
- ASSESM_I
- ASSESM_I_1
- ASSESM_J
- ASSESM_J_1
- ASSESM_K
- ASSESM_K_1
- ASSESM_L
- ASSESM_L_1
The routing in AR 40-66 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 TSG or to the administrative office servicing your unit.
Questions and answers
- What is DA Form 5569?
- ISONIAZID (INH) CLINIC FLOW SHEET
- Which edition is current?
- 02/01/2003
- 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,