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DA Form 5190 is a DA series document issued for use across the Department of the Army. Official title: CLINICIAN`S INFORMATION. Purpose: clinician`s information. The current edition carries the date 02/01/2026 and is listed with a publication status of ACTIVE. The form runs to 2 page(s) and contains approximately 128 entry fields.
The office of primary responsibility is TSG. Use is prescribed by AR 608-75, which defines when the form is raised and where it goes afterward. The form is normally completed by the subject of the entries or by administrative personnel maintaining the record, then reviewed and signed as the governing authority directs. A more recent edition has been published. This edition is superseded; it remains available for reference and for files already executed against it.
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.
The pdf displays in current browsers and in any reader application. For fillable use a full reader is preferable to a browser viewer, since viewers vary in whether entered data is retained. An xfdl file is available too. The format is IBM Lotus Forms, in use across Army form systems, and it opens only in the Lotus Forms Viewer.
Every format is available at no charge and without sign-up. Files are distributed exactly as published, with no changes to the page.
What the form asks for
- ADDRESS
- BIRTHDATE
- CARE_NEED
- CARE_NEED_1
- CARE_NEED_10
- CARE_NEED_11
- CARE_NEED_2
- CARE_NEED_3
- CARE_NEED_4
- CARE_NEED_5
- CARE_NEED_6
- CARE_NEED_7
- CARE_NEED_8
- CARE_NEED_9
- ContentArea1
- DATE_A
- DATE_B
- NAME
- OTHER2
- PHYSICIAN
- Page1
- Page2
- R45
- R46
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.
Fillable fields accept typing directly. Tab advances from one field to the next in the order the form was built, which is normally the reading order of the page. Check boxes and option buttons are clicked; where a set of options is exclusive, selecting one clears the rest. Fields sized for a single line will not wrap, and text exceeding the width is truncated in print even where it remains visible on screen. Long entries belong in the remarks area or on a continuation, not compressed into a narrow field.
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.
Where personal information is gathered, the form carries a Privacy Act statement giving the collection authority, the purpose, the routine uses, and the mandatory or voluntary character of the disclosure. It is read before entries are made rather than afterwards. A completed copy holds personal data and is stored and transmitted under the corresponding safeguards.
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.
Associated documents are located through the series and number scheme. Forms in the DA series with the same proponent or the same prescribing directive tend to be used as a set, and any form named on the face of another normally accompanies it. Continuations, cover sheets, and transmittals fall into this category and are gathered before the package is sent.
Revision by the proponent supersedes an edition. Version is read from the edition date printed on the form itself, and a stored copy is compared against the current edition before it is used again. Documents already executed under an earlier edition are not redone because of the change.
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 5190?
- CLINICIAN`S INFORMATION
- Which edition is current?
- 02/01/2026
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF