What does this form do? DA Form 5440-3 is titled DELINEATION OF CLINICAL PRIVILEGES-INTERNAL MEDICINE, and its job is to delineation of clinical privileges-internal medicine. Anyone sent to find "the 5440-3" is being sent here. Everything below expands on that one function.
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
Which formats can I download? These: PDF, XFDL. All of them carry the same published page — the difference is not what the form says but how you get words onto it.
Should I take the fillable pdf or the printable one? Take the fillable version if you will type, since its entry areas respond to the keyboard and hold what you enter. Take the printable version if you will write by hand — it is the same blank form as a flat page image. The finished result looks the same either way.
Do I need special software? Not for reading — a pdf opens in the browser you already have. For filling, install a full pdf reader rather than trusting the in-browser viewer, which sometimes displays fields it cannot save. Type into one field, save, reopen and confirm the text survived. Why will my xfdl file not open? Because it is IBM Lotus Forms, not pdf. The Lotus Forms Viewer is the only application that reads it.
Is it free? Yes, entirely. No registration stands between you and the file, and what arrives is exactly what the publisher released.
What goes in first? The heading block — your name exactly as official records show it, then identification number, then organisation, then the date you prepared the form. Is the order important? It is, because those four entries become the index for the finished record, and an error there is the one mistake that hides the document from everyone looking for it.
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.
Can a field hold a long answer? Not if it is sized for one line — there is no wrap, and the excess prints missing while remaining visible as you type. So where does the extra text belong? In the remarks area or a continuation sheet. Should you skip fields that are irrelevant to your case? No. Mark them accordingly, because an empty field reads as an oversight rather than an answer.
Where does the signature belong in the sequence? At the very end, by hand or by an accepted electronic means. An unsigned form is a draft regardless of how full it is. Are countersignatures needed? Where the form provides for them — reviewing official, approving authority, witness — taken in printed order and dated on the day applied. What should you check before releasing it? Empty mandatory fields, digit transposition in identification numbers, day-month inversion in dates, and residue from an old copy used in place of a blank one.
Why does the form carry a Privacy Act statement? Because personal information is being collected, and the statement declares the authority, the purpose, who else routinely sees the data, and whether answering is required or optional. Is it worth reading? Read it before you fill the fields it governs, not after. Does it change how you keep the file? It should — a filled copy is a personal record and gets the handling such records receive.
Where do you send it? To the destination the prescribing directive names, which may be a specific office, the unit administrative channel, or the individual's file. Is a copy worth keeping? Always, and taken before submission. How long does the receiving office keep it? For the period the records schedule for the series prescribes, regardless of local custom.
How do you find related forms? By series and number. Documents in the DA series sharing a proponent or a prescribing directive are commonly used together, and a form cited on the face of another usually goes forward with it. When should you gather them? Before submission — continuation sheets, cover sheets and transmittal documents belong in the package from the start.
When is an edition replaced? When the proponent revises the form and publishes a new edition date. What should you do with a copy kept on your own machine? Check its date against the edition in force before reusing it. Does the change reach backwards? It does not; work already completed on an earlier edition remains valid as filed.
Is this an official Department of the Army site? No. It is an independent site distributing reproductions of published Department of the Army documents for download, with no authority to issue forms. Does it guarantee acceptance of anything you submit? It does not, and nothing on the page is legal advice. Who should you ask instead? TSG or your servicing administrative office, whenever an entry, a requirement or your eligibility is in doubt.
Questions and answers
- What is DA Form 5440-3?
- DELINEATION OF CLINICAL PRIVILEGES-INTERNAL MEDICINE
- 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
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)