Download the form
DA Form 5223-R exists to child development services (cds) child health assessment (lra) — that is the short version. Title of record: CHILD DEVELOPMENT SERVICES (CDS) CHILD HEALTH ASSESSMENT. The page covers the download, the entries and the disposition, nothing else. Current here: edition July 1989, status not stated, 2 page(s), near 200 fields.
ACSIM is the proponent, AR 608-10 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, XFDL, 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.
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
- ACTIVITY
- ADMINSTR
- ADMINSTR_1
- ADMINSTR_2
- ALLERGIES
- ASTHMA_N
- ASTHMA_Y
- AUDTPROB_N
- AUDTPROB_Y
- BEDWETS
- CHICKPOX_N
- CHICKPOX_Y
- CHILD_DOB
- CHILD_NAME
- COLDS
- COMENTS
- CONSTIP
- ContentArea1
- ContentArea2
- DATE_A
- DATE_B
- DIABETES_N
- DIABETES_Y
- DIARRHEA
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.
The signature closes the form and nothing precedes it. Draft status holds until it is applied, by hand or by an accepted electronic method. Countersignatures go in printed order, each dated at signing. Then one final read from the top, looking for the four recurring defects: empty mandatory fields, swapped digits in identification numbers, day-month inversion in dates, and residue from a reused file that goes forward as though intended.
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.
Routing follows AR 608-10 and nothing else — a named office, the unit administrative channel, or the individual's file, according to why the form was raised. Copy it before it leaves. Retention is fixed by the records schedule for the series, which local practice does not shorten or extend.
Companion documents come from the same series and number scheme. Within the DA series, a shared proponent or a shared directive usually means shared use, and a form cited on the face of another accompanies it. Gather the whole package first — continuation sheets, cover sheets, transmittals.
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.
What is distributed here are reproductions of published Department of the Army documents. Independent site, no official standing, no forms of its own. Nothing on the page constitutes legal advice, and acceptance by any office is outside what can be stated. Put questions about entries, requirements or eligibility to ACSIM or your servicing administrative office.
Questions and answers
- What is DA Form 5223-R?
- CHILD DEVELOPMENT SERVICES (CDS) CHILD HEALTH ASSESSMENT
- Which edition is current?
- July 1989
- Who is responsible for this form?
- ACSIM
- In which formats can it be downloaded?
- PDF, XFDL