Download the form
DA Form 5195 handles one job: health data. The official title is HEALTH DATA. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 01/01/2026, status ACTIVE, running 1 page(s) with about 196 fields to complete. This edition is superseded — pull the newer one unless your record was already executed on this version.
G-1 is the proponent, AR 608-18 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.
PDF, XFDL are available and the decision takes one second. Type your entries: fillable pdf. Write them: printable pdf. The published layout is common to both, so the format governs your method and nothing more.
A standalone reader is the safe choice for fillable work. Browser viewers vary in whether entered data survives the session, and there is no warning when it does not; a one-field save test settles it in seconds. Xfdl means IBM Lotus Forms. The Lotus Forms Viewer opens it; pdf readers and word processors do not.
Free, unregistered, unmodified. What arrives is what the publisher released.
What the form asks for
- BIRTHDAY
- CASENUM
- CHILDNAME
- COMMDATE
- COMMDATEA
- COMMDATEA_1
- COMMDATEA_2
- COMMDATEA_3
- COMMDATEA_4
- COMMDATE_1
- COMMDATE_2
- ContentArea1
- DATE
- DATEA
- DATEAB
- DATEB
- DATEC
- DATED
- DDATE
- DDATEB
- DDATEB_1
- DDATE_1
- DDATE_2
- DDATE_3
Start at the top and get the header exactly right. Official spelling of the name, identification number, unit, date. Everything downstream finds the record through those entries; nothing else on the page has that consequence.
Tabbing beats clicking for coverage. The order was set at build time and tracks the page layout, so following it leaves no gaps. Boxes and buttons are clicked; where options are exclusive, one selection cancels another by design. Watch field width on long entries: one-line fields have no wrap, and what runs past the edge disappears in print though the screen still shows it. Move that text to remarks or a continuation. Never leave an inapplicable field empty — enter the nil mark, because a reviewer cannot distinguish a skipped question from a considered answer.
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.
The prescribing directive names the destination; office custom does not. Depending on the case that means a specific office, the unit administrative channel, or the personal record. Keep a copy first, because the original does not come back. Retention runs on the applicable records schedule.
Related forms are found by series and number. DA series documents under the same proponent or the same prescribing directive are commonly required as a set, and any form named on the face of this one goes forward with it. Assemble continuations, covers and transmittals before submitting, not after the query comes back.
Check the edition date before reusing a saved copy. Revisions come from the proponent without notice to you, and the printed date is the only version marker on the page. Already-submitted records under a superseded edition stand as filed; the change does not run backwards.
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 G-1 or the administrative office servicing your unit.
Questions and answers
- What is DA Form 5195?
- HEALTH DATA
- Which edition is current?
- 01/01/2026
- Who is responsible for this form?
- G-1
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- PRIVACY ACT STATEMENT