Download the form
DA Form 4221 handles one job: diabetic record. The official title is DIABETIC RECORD. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 02/01/2003, status ACTIVE, running 2 page(s) with about 200 fields to complete.
TSG is the proponent, AR 40-66 the prescribing authority. Read the directive only if something about your situation departs from the standard case. Otherwise the form is filled by the individual it describes, or by the records clerk keeping the file, and reviewed through the printed signature blocks.
The formats are PDF, and the choice comes down to keyboard or pen. Fillable pdf for typing — live fields, tab order, saved entries. Printable pdf for handwriting — same page, no interactive objects, print it blank. Content is identical; only entry method differs.
Save the download and open it in a dedicated reader. That single step prevents the common failure: an in-browser viewer accepts your typing and discards it at tab close. Confirm with one field and one save cycle before committing the whole form.
No charge, no account, no email address. The file is the published document, distributed unaltered.
What the form asks for
- BLCO2_A
- BLCO2_A_1
- BLCO2_A_10
- BLCO2_A_11
- BLCO2_A_12
- BLCO2_A_13
- BLCO2_A_14
- BLCO2_A_15
- BLCO2_A_16
- BLCO2_A_17
- BLCO2_A_18
- BLCO2_A_19
- BLCO2_A_2
- BLCO2_A_20
- BLCO2_A_3
- BLCO2_A_4
- BLCO2_A_5
- BLCO2_A_6
- BLCO2_A_7
- BLCO2_A_8
- BLCO2_A_9
- BLCO2_B
- BLCO2_B_1
- BLCO2_B_10
Header first, always. Name as your official records spell it, identification number, unit, date of preparation — these four index the finished record, and an error in them hides the document from anyone searching for it later. The substantive blocks can wait thirty seconds.
Move between fields with tab; the build-time order follows the page and misses nothing. Click check boxes and option buttons, and expect an exclusive group to release the old choice when you set a new one. The trap is field width. Single-line fields do not wrap, so an overlong entry displays complete on screen and prints cut at the margin — put it in remarks or on a continuation instead. Mark inapplicable fields rather than leaving them blank, since an empty box carries no information about whether the question was read.
Signature comes after every other entry — ink or an approved electronic means, and without it the document is a draft. Where reviewing, approving or witnessing signatures are called for, take them in printed block order, each dated on the day applied. Before release, one pass from the top. The defects worth hunting are always the same four: mandatory fields left empty, identification digits transposed, dates with day and month reversed, and stale data surviving in a copy reused in place of a blank form.
The Privacy Act statement is read before the personal entries, not after. It gives the collection authority, the purpose, the routine uses and whether disclosure is mandatory or voluntary. Once filled, your copy is a personal record and gets stored and transmitted accordingly.
Send it where the directive says: the office it names, the unit administrative channel, or the individual's file. Take your copy before submission. How long the record is held comes from the schedule for the series, not from the office holding it.
Look for associated forms by series and number. In the DA series, documents sharing a proponent or a governing directive tend to travel together, and anything referenced on the page normally submits alongside. Collect continuations, covers and transmittals in advance of sending.
Edition date is the version number, printed on the page. Hold a locally saved copy against the current edition before reuse, since nothing on your machine signals a revision. Work already executed under a superseded edition remains as filed.
The files are copies of published Department of the Army forms. This site has no official connection, no authority to issue anything, and no basis for saying whether an office will accept a given submission. None of the text is legal advice. Real questions — entry, requirement, eligibility — belong with TSG or the administrative office servicing your unit.
Questions and answers
- What is DA Form 4221?
- DIABETIC RECORD
- Which edition is current?
- 02/01/2003
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, PDF
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)