DA Forms 5440 - 5441

The United States Army medical facilities use various forms to document clinical privileges for healthcare practitioners. These forms are essential to ensure that the practitioners have been granted the appropriate level of clinical privileges to perform their duties safely and efficiently. These forms are also used to verify the credentials and qualifications of the practitioners, ensuring that they meet the required standards.

• DA Form 5440 - Delineation of Clinical Privileges-Anesthesia: A form used to document clinical privileges for anesthesia practitioners in Army medical facilities.
• DA Form 5440-1 - Delineation of Clinical Privileges-Dentistry: A form used to document clinical privileges for dentists in Army medical facilities.
• DA Form 5440-2 - Delineation of Clinical Privileges-Family Practice: A form used to document clinical privileges for family practice practitioners in Army medical facilities.
• DA Form 5440-3 - Delineation of Clinical Privileges-Internal Medicine: A form used to document clinical privileges for internal medicine practitioners in Army medical facilities.
• DA Form 5440-4 - Delineation of Clinical Privileges-Neurology: A form used to document clinical privileges for neurologists in Army medical facilities.
• DA Form 5440-5 - Delineation of Clinical Privileges-Obstetrics and Gynecology: A form used to document clinical privileges for obstetricians and gynecologists in Army medical facilities.
• DA Form 5440-6 - Delineation of Clinical Privileges-Optometry Service: A form used to document clinical privileges for optometrists in Army medical facilities.
• DA Form 5440-7 - Delineation of Clinical Privileges-Pathology: A form used to document clinical privileges for pathologists in Army medical facilities.
• DA Form 5440-8 - Delineation of Clinical Privileges-Pediatrics: A form used to document clinical privileges for pediatric practitioners in Army medical facilities.
• DA Form 5440-9 - Delineation of Clinical Privileges-Podiatry: A form used to document clinical privileges for podiatrists in Army medical facilities.
• DA Form 5440-10 - Delineation of Clinical Privileges-Psychiatry: A form used to document clinical privileges for psychiatrists in Army medical facilities.
• DA Form 5440-11 - Delineation of Clinical Privileges-Psychology: A form used to document clinical privileges for psychologists in Army medical facilities.
• DA Form 5440-12 - Delineation of Clinical Privileges-Diagnostic Radiology: A form used to document clinical privileges for diagnostic radiologists in Army medical facilities.
• DA Form 5440-13 - Delineation of Clinical Privileges-General Surgery: A form used to document clinical privileges for general surgeons in Army medical facilities.
• DA Form 5440-14 - Delineation of Clinical Privileges-Nurse Anesthetists: A form used to document clinical privileges for nurse anesthetists in Army medical facilities.
• DA Form 5440-15 - Delineation of Clinical Privileges-Certified Nurse Midwives: A form used to document clinical privileges for certified nurse midwives in Army medical facilities.
• DA Form 5440-16 - Delineation of Clinical Privileges-Nurse Practitioner: A form used to document clinical privileges for nurse practitioners in Army medical facilities.
• DA Form 5440-18 - Delineation of Clinical Privileges - Physician Assistant: A form used to document clinical privileges for physician assistants in Army medical facilities.
• DA Form 5440-19 - Delineation of Clinical Privileges-Dietetics: A form used to document clinical privileges for dietitians in Army medical facilities.
• DA Form 5440-20 - Delineation of Clinical Privileges-Occupational Therapy: A form used to document clinical privileges for occupational therapists in Army medical facilities.
• DA Form 5440-21 - Delineation of Clinical Privileges-Physical Therapy: A form used to document clinical privileges for physical therapists in Army medical facilities.
• DA Form 5440-22 - Delineation of Clinical Privileges: A form used to document clinical privileges for various medical specialties in Army medical facilities.
• DA Form 5440-23 - Delineation of Clinical Privileges-Emergency Medicine: A form used to document clinical privileges for emergency medicine practitioners in Army medical facilities.
• DA Form 5440-24 - Delineation of Clinical Privileges-Aerospace Medicine: A form used to document clinical privileges for aerospace medicine practitioners in Army medical facilities.
• DA Form 5440-25 - Delineation of Clinical Privileges-General Medical Officer: A form used to document clinical privileges for general medical officers in Army medical facilities.
• DA Form 5440-28 - Delineation of Clinical Privileges - Social Work: A form used to document clinical privileges for social workers in Army medical facilities.
• DA Form 5440-29 - Delineation of Clinical Privileges - Allergy/Immunology: A form used to document clinical privileges for allergy and immunology practitioners in Army medical facilities.
• DA Form 5440-30 - Delineation of Clinical Privileges - Nephrology: A form used to document clinical privileges for nephrologists in Army medical facilities.
• DA Form 5440-31 - Delineation of Clinical Privileges - Chiropractic: A form used to document clinical privileges for chiropractors in Army medical facilities.
• DA Form 5440-32 - Delineation of Clinical Privileges - Dermatology: A form used to document clinical privileges for dermatologists in Army medical facilities.
• DA Form 5440-33 - Delineation of Clinical Privileges - Urology: A form used to document clinical privileges for urologists in Army medical facilities.
• DA Form 5440-34 - Delineation of Clinical Privileges - Behavioral Health Practitioner: A form used to document clinical privileges for behavioral health practitioners in Army medical facilities.
• DA Form 5440-35 - Delineation of Clinical Privileges - Psychological Associate: A form used to document clinical privileges for psychological associates in Army medical facilities.
• DA Form 5440-36 - Delineation of Clinical Privileges - Audiology: A form used to document clinical privileges for audiologists in Army medical facilities.
• DA Form 5440-37 - Delineation of Clinical Privileges - Speech Pathology: A form used to document clinical privileges for speech pathologists in Army medical facilities.
• DA Form 5440-38 - Delineation of Clinical Privileges - Clinical Pharmacy: A form used to document clinical privileges for clinical pharmacists in Army medical facilities.
• DA Form 5440-39 - Delineation of Clinical Privileges - Nuclear Medicine: A form used to document clinical privileges for nuclear medicine practitioners in Army medical facilities.
• DA Form 5440-40 - Delineation of Clinical Privileges - Therapeutic Radiology: A form used to document clinical privileges for therapeutic radiologists in Army medical facilities.
• DA Form 5440-41 - Delineation of Clinical Privileges - Physical Medicine and Rehabilitation: A form used to document clinical privileges for physical medicine and rehabilitation practitioners in Army medical facilities.
• DA Form 5440-42 - Delineation of Clinical Privileges - Cardiology: A form used to document clinical privileges for cardiologists in Army medical facilities.
• DA Form 5440-43 - Delineation of Clinical Privileges - Ophthalmology: A form used to document clinical privileges for ophthalmologists in Army medical facilities.
• DA Form 5440-44 - Delineation of Clinical Privileges - Otolaryngology: A form used to document clinical privileges for otolaryngologists in Army medical facilities.
• DA Form 5440-45 - Delineation of Clinical Privileges - Cardiovascular Surgery: A form used to document clinical privileges for cardiovascular surgeons in Army medical facilities.
• DA Form 5440-46 - Delineation of Clinical Privileges - Pulmonary Disease: A form used to document clinical privileges for pulmonologists in Army medical facilities.
• DA Form 5440-47 - Delineation of Clinical Privileges - Preventive Medicine: A form used to document clinical privileges for preventive medicine practitioners in Army medical facilities.
• DA Form 5440-48 - Delineation of Clinical Privileges - Oral & Maxillofacial Surgery: A form used to document clinical privileges for oral and maxillofacial surgeons in Army medical facilities.
• DA Form 5440-49 - Delineation of Clinical Privileges - Plastic Surgery: A form used to document clinical privileges for plastic surgeons in Army medical facilities.
• DA Form 5440-50 - Delineation of Clinical Privileges - Vascular Surgery: A form used to document clinical privileges for vascular surgeons in Army medical facilities.
• DA Form 5440-51 - Delineation of Clinical Privileges - Neurosurgery: A form used to document clinical privileges for neurosurgeons in Army medical facilities.
• DA Form 5440-52 - Delineation of Clinical Privileges - Critical Care Medicine: A form used to document clinical privileges for critical care practitioners in Army medical facilities.
• DA Form 5440-53 - Delineation of Clinical Privileges - Occupational Medicine: A form used to document clinical privileges for occupational medicine practitioners in Army medical facilities.
• DA Form 5440-54 - Delineation of Clinical Privileges - Thoracic Surgery: A form used to document clinical privileges for thoracic surgeons in Army medical facilities.
• DA Form 5440-55 - Delineation of Clinical Privileges - Orthopaedics: A form used to document clinical privileges for orthopaedic surgeons in Army medical facilities.
• DA Form 5440-56 - Delineation of Clinical Privileges - Blood Services: A form used to document clinical privileges for blood services personnel in Army medical facilities.
• DA Form 5440-57 - Delineation of Clinical Privileges - Psychiatric Advanced Practice Nurse: A form used to document clinical privileges for psychiatric advanced practice nurses in Army medical facilities.
• DA Form 5440-58 - Delineation of Clinical Privileges - Substance Abuse Rehabilitation: A form used to document clinical privileges for substance abuse rehabilitation practitioners in Army medical facilities.
• DA Form 5440A - Approval of Clinical Privileges/Staff Appointment: A form used to approve clinical privileges and staff appointments for healthcare providers in Army medical facilities.
• DA Form 5441 - Evaluation of Clinical Privileges - Anesthesia: A form used to evaluate clinical privileges for anesthesiologists in Army medical facilities.
• DA Form 5441-1 - Evaluation of Clinical Privileges-Dentistry: A form used to evaluate clinical privileges for dentists in Army medical facilities.
• DA Form 5441-2 - Evaluation of Clinical Privileges-Family Practice: A form used to evaluate clinical privileges for family practice physicians in Army medical facilities.
• DA Form 5441-3 - Evaluation of Clinical Privileges-Internal Medicine: A form used to evaluate clinical privileges for internal medicine physicians in Army medical facilities.
• DA Form 5441-4 - Evaluation of Clinical Privileges-Neurology: A form used to evaluate clinical privileges for neurologists in Army medical facilities.
• DA Form 5441-5 - Evaluation of Clinical Privileges-Obstetrics and Gynecology: A form used to evaluate clinical privileges for obstetricians and gynecologists in Army medical facilities.
• DA Form 5441-6 - Evaluation of Clinical Privileges-Optometry: A form used to evaluate clinical privileges for optometrists in Army medical facilities.
• DA Form 5441-7 - Evaluation of Clinical Privileges-Pathology: A form used to evaluate clinical privileges for pathologists in Army medical facilities.
• DA Form 5441-8 - Evaluation of Clinical Privileges-Pediatrics: A form used to evaluate clinical privileges for pediatricians in Army medical facilities.
• DA Form 5441-9 - Evaluation of Clinical Privileges-Podiatry: A form used to evaluate clinical privileges for podiatrists in Army medical facilities.
• DA Form 5441-10 - Evaluation of Clinical Privileges-Psychiatry: A form used to evaluate clinical privileges for psychiatrists in Army medical facilities.
• DA Form 5441-11 - Evaluation of Clinical Privileges - Clinical Psychology: A form used to evaluate clinical privileges for clinical psychologists in Army medical facilities.
• DA Form 5441-12 - Evaluation of Clinical Privileges - Diagnostic Radiology: A form used to evaluate clinical privileges for diagnostic radiologists in Army medical facilities.
• DA Form 5441-13 - Evaluation of Clinical Privileges - General Surgery: A form used to evaluate clinical privileges for general surgeons in Army medical facilities.
• DA Form 5441-14 - Evaluation of Clinical Privileges-Nurse Anesthetist: A form used to evaluate clinical privileges for nurse anesthetists in Army medical facilities.
• DA Form 5441-15 - Evaluation of Clinical Privileges - Certified Nurse Midwife: A form used to evaluate clinical privileges for certified nurse midwives in Army medical facilities.
• DA Form 5441-16 - Evaluation of Clinical Privileges - Nurse Practitioner: A form used to evaluate clinical privileges for nurse practitioners in Army medical facilities.
• DA Form 5441-18 - Evaluation of Clinical Privileges - Physician Assistant: A form used to evaluate clinical privileges for physician assistants in Army medical facilities.
• DA Form 5441-19 - Evaluation of Clinical Privileges - Dietetics: A form used to evaluate clinical privileges for dietitians in Army medical facilities.
• DA Form 5441-20 - Evaluation of Clinical Privileges - Occupational Therapy: A form used to evaluate clinical privileges for occupational therapists in Army medical facilities.
• DA Form 5441-21 - Evaluation of Clinical Privileges - Physical Therapy: A form used to evaluate clinical privileges for physical therapists in Army medical facilities.
• DA Form 5441-22 - Evaluation of Clinical Privileges: A form used to evaluate clinical privileges for healthcare providers in Army medical facilities.
• DA Form 5441-23 - Evaluation of Clinical Privileges - Emergency Medicine: A form used to evaluate clinical privileges for emergency medicine physicians in Army medical facilities.
• DA Form 5441-24 - Evaluation of Clinical Privileges - Aerospace Medicine: A form used to evaluate clinical privileges for aerospace medicine practitioners in Army medical facilities.
• DA Form 5441-25 - Evaluation of Clinical Privileges - General Medical Officer: A form used to evaluate clinical privileges for general medical officers in Army medical facilities.
• DA Form 5441-28 - Evaluation of Clinical Privileges - Social Work: A form used to evaluate clinical privileges for social workers in Army medical facilities.
• DA Form 5441-29 - Evaluation of Clinical Privileges - Allergy/Immunology: A form used to evaluate clinical privileges for allergy and immunology specialists in Army medical facilities.
• DA Form 5441-30 - Evaluation of Clinical Privileges - Nephrology: A form used to evaluate clinical privileges for nephrologists in Army medical facilities.
• DA Form 5441-31 - Evaluation of Clinical Privileges - Chiropractic: A form used to evaluate clinical privileges for chiropractors in Army medical facilities.
• DA Form 5441-32 - Evaluation of Clinical Privileges - Dermatology: A form used to evaluate clinical privileges for dermatologists in Army medical facilities.
• DA Form 5441-33 - Evaluation of Clinical Privileges - Urology: A form used to evaluate clinical privileges for urologists in Army medical facilities.
• DA Form 5441-34 - Evaluation of Clinical Privileges - Behavioral Health Practitioner: A form used to evaluate clinical privileges for behavioral health practitioners in Army medical facilities.
• DA Form 5441-35 - Evaluation of Clinical Privileges - Psychological Associate: A form used to evaluate clinical privileges for psychological associates in Army medical facilities.
• DA Form 5441-36 - Evaluation of Clinical Privileges - Audiology: A form used to evaluate clinical privileges for audiologists in Army medical facilities.
• DA Form 5441-37 - Evaluation of Clinical Privileges - Speech Pathology: A form used to evaluate clinical privileges for speech pathologists in Army medical facilities.
• DA Form 5441-38 - Evaluation of Clinical Privileges - Clinical Pharmacy: A form used to evaluate clinical privileges for clinical pharmacists in Army medical facilities.
• DA Form 5441-39 - Evaluation of Clinical Privileges - Nuclear Medicine: A form used to evaluate clinical privileges for nuclear medicine practitioners in Army medical facilities.
• DA Form 5441-40 - Evaluation of Clinical Privileges - Therapeutic Radiology: A form used to evaluate clinical privileges for therapeutic radiologists in Army medical facilities.
• DA Form 5441-41 - Evaluation of Clinical Privileges - Physical Medicine and Rehabilitation: A form used to evaluate clinical privileges for physical medicine and rehabilitation specialists in Army medical facilities.
• DA Form 5441-42 - Evaluation of Clinical Privileges - Cardiology: A form used to evaluate clinical privileges for cardiologists in Army medical facilities.
• DA Form 5441-43 - Evaluation of Clinical Privileges - Ophthalmology: A form used to evaluate clinical privileges for ophthalmologists in Army medical facilities.
• DA Form 5441-44 - Evaluation of Clinical Privileges - Otolaryngology: A form used to evaluate clinical privileges for otolaryngologists in Army medical facilities.
• DA Form 5441-45 - Evaluation of Clinical Privileges - Cardiovascular Surgery: A form used to evaluate clinical privileges for cardiovascular surgeons in Army medical facilities.
• DA Form 5441-46 - Evaluation of Clinical Privileges - Pulmonary Disease: A form used to evaluate clinical privileges for pulmonary disease specialists in Army medical facilities.
• DA Form 5441-47 - Evaluation of Clinical Privileges - Preventive Medicine: A form used to evaluate clinical privileges for preventive medicine specialists in Army medical facilities.
• DA Form 5441-48 - Evaluation of Clinical Privileges - Oral & Maxillofacial Surgery: A form used to evaluate clinical privileges for oral and maxillofacial surgeons in Army medical facilities.
• DA Form 5441-49 - Evaluation of Clinical Privileges - Plastic Surgery: A form used to evaluate clinical privileges for plastic surgeons in Army medical facilities.
• DA Form 5441-50 - Evaluation of Clinical Privileges - Vascular Surgery: A form used to evaluate clinical privileges for vascular surgeons in Army medical facilities.
• DA Form 5441-51 - Evaluation of Clinical Privileges - Neurosurgery: A form used to evaluate clinical privileges for neurosurgeons in Army medical facilities.
• DA Form 5441-52 - Evaluation of Clinical Privileges - Critical Care Medicine: A form used to evaluate clinical privileges for critical care medicine specialists in Army medical facilities.
• DA Form 5441-53 - Evaluation of Clinical Privileges - Occupational Medicine: A form used to evaluate clinical privileges for occupational medicine specialists in Army medical facilities.
• DA Form 5441-54 - Evaluation of Clinical Privileges - Thoracic Surgery: A form used to evaluate clinical privileges for thoracic surgeons in Army medical facilities.
• DA Form 5441-55 - Evaluation of Clinical Privileges - Orthopaedics: A form used to evaluate clinical privileges for orthopedic surgeons in Army medical facilities.
• DA Form 5441-56 - Evaluation of Clinical Privileges - Blood Services: A form used to evaluate clinical privileges for blood service specialists in Army medical facilities.
• DA Form 5441-57 - Evaluation of Clinical Privileges - Psychiatric Advanced Practice Nurse: A form used to evaluate clinical privileges for psychiatric advanced practice nurses in Army medical facilities.
• DA Form 5441-58 - Evaluation of Clinical Privileges - Substance Abuse Rehabilitation: A form used to evaluate clinical privileges for substance abuse rehabilitation specialists in Army medical facilities.

In conclusion, the use of forms such as DA Form 5440 is essential in ensuring that healthcare practitioners in the Army medical facilities have been granted appropriate and verified clinical privileges to practice within their respective fields. These forms provide a standardized framework for documenting the credentials and qualifications of practitioners, ensuring that they meet the required standards for their specialties. The form also highlights restrictions or limitations on clinical privileges granted to each practitioner, which ensures patient safety, quality care delivery, and efficient utilization of resources.

It is important to note that the specific form used depends on the practitioner's field of practice, and each form is updated regularly to align with changes in the practitioner's qualifications or policies within the facility. The availability and use of these forms are crucial for ensuring patient safety and well-being, as well as providing assurance to patients that they are receiving quality care from trained and qualified practitioners in Army medical facilities.