DA Form 1970, House Staff Evaluation Report , is a non-mandatory document associated with the evaluation of progression and performance required for each Graduate Medical Education (GME) program participant.
The latest version of the form - sometimes confused with DD Form 1970, Motor Equipment Utilization Record - was released by the U.S. Department of the Army (DA) on May 1, 2009 , with all previous editions being obsolete. An up-to-date fillable DA Form 1970 is available for download down below or can be found on the Army Publishing Directorate website.
Filing procedures for the DA Form 1970 are as follows:
The form requires the name, grade, intern status (rotating or straight), and specialty of the participant along with the name of the hospital and the period of service covered by the report.
Part I, Clinical Performance , contains Sections A through F. Each section contains a scale from 1 to 4. The participant's performance is numerically rated on each criterion within the provided range:
Part II, Assuming Responsibilities , contains three more sections:
Part III, Personal Qualities Assessment , covers Sections J through M:
Part IV, Overall Evaluation , requires counseling with the House Officers done by the rater.
Part V, Recommendation for Additional Training , contains suggestions for additional training in case any is needed.
Part VI, Narrative Description , contains an additional block for an in-depth written description of the participant's performance and personal qualities.
DA Form 1970 needs to be verified by the signatures of the Service Chief, the Director of Medical Education, and a hospital or facility commander.