Which form is this? DA Form 5440-25, official title DELINEATION OF CLINICAL PRIVILEGES-GENERAL MEDICAL OFFICER, used to delineation of clinical privileges-general medical officer. That is the whole answer in one sentence. What follows explains the version, the file and the entries.
Is this the current version? The edition offered here is dated 02/01/2004, published with the status ACTIVE. That date is the version number of a military form; there is no other. And no, this is not the newest one. A later edition has been published, and this copy is kept only for reference and for records already completed on it.
Who is responsible for this document? TSG maintains it, and AR 40-68 prescribes when it is used and where it goes. Completion falls to the person the entries describe or to the administrative staff holding the file. As for effort: 3 page(s), roughly unknown fields.
Download the form
What file types are offered? PDF, XFDL. The page image is the same in every one of them; only the way you complete it changes from format to format.
What is the difference between fillable and printable? A fillable pdf has live fields that accept typing and can be saved with your entries in place. A printable pdf is the same blank page with no live fields, meant to come out of a printer and be completed with a pen. Both print identically once filled.
Which application should I use? Reading takes nothing beyond a browser. Filling takes a proper pdf reader, since browser viewers vary in whether they retain what you type — verify with a single field and a save before you fill the whole form. What is xfdl? The IBM Lotus Forms format used inside Army systems. It requires the Lotus Forms Viewer; nothing else opens it.
Do I have to sign up? No. Every format is free, no account is involved, and the file is distributed unmodified.
Where do you start? At the top of the page, with the identifying entries: name as your official records spell it, identification number, unit or organisation, date of preparation. Why first? Because those entries are what the form is filed and searched under later, and a record indexed on a misspelled name is a record nobody retrieves.
How should you work through the entry fields? With the tab key. It follows the order the form was constructed in, which is usually the order the page reads, so nothing gets passed over. Do check boxes work the same way? They are clicked rather than tabbed into. In an exclusive group, a second click elsewhere clears your first choice, as intended.
What happens if your answer is too long for the field? It prints cut off. A single-line field does not wrap, so text running past the edge stays readable on screen and then disappears at the margin on paper. What do you do instead? Move it to the remarks area or onto a continuation sheet. And a field that does not apply to you? Mark it as not applicable rather than leaving it blank — an empty box tells the reviewer nothing about whether you read the question.
When do you sign? Last, after every other entry is settled. Until the signature is applied the document is a draft, however complete it looks. What if more than one signature is required? Reviewing official, approving authority and witness sign in the order the blocks print, and each dates the form on the day of signing rather than the day it was prepared. What goes wrong most often? Mandatory fields left empty, transposed digits in identification numbers, dates with day and month reversed, and old entries surviving in a working copy that was reused instead of a fresh blank form.
What is the Privacy Act statement on the page? A notice appearing wherever personal information is collected, setting out the authority for the collection, the purpose, the routine uses, and whether your disclosure is mandatory or voluntary. When should you read it? At the point you reach it, before entering the details it covers. And afterwards? Your completed copy holds personal data and is stored and transmitted under the rules that apply to such records.
Where does the finished form go? Wherever AR 40-68 says — to the office it names, along your unit administrative channel, or into the individual's own record, depending on why it was raised. Should you keep a copy? Yes, before it leaves your hands. How long is it held? The records schedule for the series decides that, and local practice does not override it.
What if this form is not the only one you need? Search by series and number. Within the DA series, forms under the same proponent or the same prescribing directive tend to be required as a set, and anything named on the face of one normally accompanies it. Are continuations part of that? They are, along with covers and transmittals, and all of them are collected in advance rather than after a query.
Why do editions change? Because the proponent revises the content, and the edition date printed on the page marks the result. How do you tell whether a stored copy is still current? Compare its printed date against the edition in force before you use it again. Does a new edition invalidate what you already filed? No. Records executed under a superseded edition stand as they are.
What exactly is this site? A place to download reproductions of published Department of the Army documents. Is it part of the Department of the Army? No — it is independent, issues no forms of its own, and has no authority over any of them. Can it tell you whether your completed form will be accepted? It cannot, and nothing written here is legal advice. Who answers the real questions? TSG or the administrative office servicing your unit, on any question of entry, requirement or eligibility.
Questions and answers
- What is DA Form 5440-25?
- DELINEATION OF CLINICAL PRIVILEGES-GENERAL MEDICAL OFFICER
- Which edition is current?
- 02/01/2004
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA