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DA Form 4221 belongs to the DA series of Department of the Army publications. Its official title is DIABETIC RECORD, and its stated purpose is diabetic record. Edition in force: 02/01/2003. Publication status: ACTIVE. Length is 2 page(s), with roughly 200 fields available for entry.
Responsibility for content and revision lies with TSG. The prescribing directive is AR 40-66, which sets both the trigger for use and the disposition of the completed document. Entry is made by the named party or by the records clerk holding the file, with review and signature applied in the prescribed order.
Available formats: PDF. Each is a rendering of the same official layout; the content is identical across them and only the means of completion differs. The pdf is the reference copy. Fillable pdf carries interactive form fields; a printable pdf is the same page image without them, intended for pen entry after printing.
Any modern browser or reader will display a pdf. Interactive fields behave more predictably in a standalone reader than in an in-browser viewer, which sometimes shows fields it cannot store.
All formats are free to download and no registration is involved. The files are the published documents, distributed unmodified.
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
Entry proceeds block by block in the order printed on the page. Identifying particulars occupy the head of the form: name, identification number, unit or organisation, and date of preparation. These fields govern how the record is later retrieved from the file, so they are completed before any substantive block.
Typed entry is made straight into the interactive fields. The tab key moves through them in the order set at build time, generally matching the reading order of the page. Boxes and buttons respond to a click; in an exclusive group, one selection cancels the others. Single-line fields do not wrap, and anything longer than the field width prints cut off although it may still display in full on screen. Extended text goes to remarks or a continuation sheet rather than into a narrow box.
The signature block is completed last and by hand or by an accepted electronic means. An unsigned form is a draft. Where a second signature is called for — reviewing official, approving authority, witness — each is applied in the order the blocks appear and dated as of application, not as of preparation. Blank mandatory fields are the most frequent defect; a nil entry is marked as such rather than left empty. Other recurring faults: transposed digits in identification numbers, dates in the wrong order of day and month, and stale copies retaining prior data because a working file was reused instead of a fresh blank form.
A Privacy Act statement appears on the form where personal information is collected. It sets out the authority for collection, the purpose, the routine uses, and whether disclosure is mandatory or voluntary. The statement is read before entry, not after. Completed copies carry personal data and are handled and stored under the safeguards applicable to that data.
Disposition of the completed document follows the prescribing authority — delivery to the office it names, transmission through the unit administrative channel, or placement in the individual's record, according to circumstance. The preparer keeps a copy. Retention is governed by the applicable records schedule, not by office custom.
Companion forms are traced by series and number. Within the DA series, documents sharing a proponent or a governing directive are frequently required together, and a form cited on the face of another is generally submitted alongside it. Continuation sheets, covers, and transmittal forms are part of that set and are assembled in advance of submission.
Editions are replaced when the proponent revises the content. The edition date printed on the form is the means of telling one version from another, and the date on a downloaded copy is checked against the edition in force before use. Records already executed on a prior edition are not reworked on that account.
The files here are reproductions of published Department of the Army documents, provided for download. This site is not part of the Department of the Army and issues no forms of its own. Nothing on this page is legal advice, and no representation is made as to acceptance of a document by any office. Where an entry, a requirement, or a question of eligibility is in doubt, the proponent or the servicing administrative office answers it.
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)