Army Forms Archive

DA Form 5179-1 — INTRAOPERATIVE DOCUMENT

intraoperative document

Download the form

DA Form 5179-1 is a Department of the Army form in the DA series. Title of record: INTRAOPERATIVE DOCUMENT. Function: intraoperative document. The edition presently published bears the date 10/01/1987, with a status of ACTIVE. Physical extent is 2 page(s) and about 200 fillable fields.

Proponency for the form rests with TSG. The governing authority is AR 40-66, which establishes the circumstances of use and the required routing. Preparation falls to the individual named in the entries or to the unit administrator acting on that individual's behalf; review and signature follow the chain set out in the governing authority.

Formats offered: PDF, XFDL. All are the same published layout in different containers, and the choice between them is a matter of how the entries will be made rather than what appears on the page. The pdf serves as the authoritative rendering. A fillable pdf exposes editable fields on screen; a printable pdf is the blank form as a flat page for handwriting.

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. An xfdl copy is published as well. It is IBM Lotus Forms, the format carried by several Army systems, and it needs the Lotus Forms Viewer; pdf readers and word processors will not open it.

Download of every format is free and requires no account. Files are served as published, without alteration to the page image.

What the form asks for

  • ADD_INFO
  • ANGRY
  • ANXIOUS
  • ARRIVED
  • A_CIRCUL
  • A_CIRCUL_1
  • A_SCRUB
  • A_SCRUB_1
  • BIPOLAR
  • BIPOLAR_NO
  • BRAND_A
  • BRAND_B
  • BYWHOM_A
  • BYWHOM_B
  • CALM
  • CARRIED
  • CARRIED_1
  • CARRIED_2
  • CARRIED_3
  • CIRCTOR_A
  • CIRCTOR_B
  • CIRCTOR_C
  • CIRCTOR_D
  • CLIP

Completion follows the printed sequence of blocks from the top of the page downward. The heading area takes the identifying particulars — name, identification number, organisation, date of preparation. Retrieval of the record from a file depends on these entries, and they are therefore filled first.

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.

Signature comes at the end, applied in ink or by an accepted electronic method. Until it is applied the document is a draft. Additional signatures — reviewer, approver, witness — are taken in printed block order, each dated when signed rather than when the form was drafted. The commonest error is a mandatory field left blank; where nothing applies, the entry is marked accordingly instead of being skipped. Transposed identification digits, day and month reversed in dates, and carried-over data from a reused working copy account for most of the remainder.

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.

The completed form is routed as the governing authority prescribes: to the office named in the directive, through the unit administrative channel, or into the individual's file, depending on the case. A copy is retained by the preparer. Filing and retention follow the records schedule applicable to the series rather than local practice.

Related forms are found by series and number. Documents in the DA series sharing a proponent or a prescribing directive commonly travel together, and a form referenced within the body of another is usually filed with it. Continuation sheets, cover sheets, and transmittal documents belong to this group and are collected before submission rather than after.

An edition stands until the proponent issues a revision. The printed edition date identifies the version, and a copy held locally is checked against the edition now in force before reuse. Prior executions under a superseded edition are not reopened for that reason.

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 5179-1?
INTRAOPERATIVE DOCUMENT
Which edition is current?
10/01/1987
Who is responsible for this form?
TSG
In which formats can it be downloaded?
PDF, XFDL, PDF

Publisher notes

  1. 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA,

Other forms in the series