Download the form
DA Form 5441-58 handles one job: evaluation of clinical privileges - substance abuse rehabilitation. The official title is EVALUATION OF CLINICAL PRIVILEGES - SUBSTANCE ABUSE REHABILITATION. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 02/01/2004, status ACTIVE, running 2 page(s) with about unknown fields to complete. This edition is superseded — pull the newer one unless your record was already executed on this version.
Two references decide everything about your use of it: TSG maintains the content, AR 40-68 sets the trigger and the routing. Consult the directive when your case is not routine; otherwise the printed blocks tell you enough. The person named in the entries fills it, or the administrative office holding the file does it for them.
Pick by how you will enter data: PDF, XFDL on offer. Typing means fillable pdf, where the boxes accept keystrokes and hold them on save. Handwriting means printable pdf, a flat page image sent straight to a printer. Neither version changes what appears on the page.
Use a full pdf reader, not the browser viewer. Browser viewers display fields they cannot always save, and the loss shows up only when you reopen the file — type one entry, save, reopen, verify, then fill the rest. The xfdl file is IBM Lotus Forms, used inside Army systems, and opens in the Lotus Forms Viewer alone — no pdf reader, no word processor.
No charge, no account, no email address. The file is the published document, distributed unaltered.
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.
Privacy Act statement first, personal entries second. The notice covers who is authorised to collect, why, who else routinely sees it, and whether you must answer. After completion the file carries personal data and is stored and sent under the corresponding safeguards.
Routing follows AR 40-68 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.
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 5441-58?
- EVALUATION OF CLINICAL PRIVILEGES - SUBSTANCE ABUSE REHABILITATION
- 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
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA,