First, confirm you are on the right form. DA Form 5440-38 carries the official title DELINEATION OF CLINICAL PRIVILEGES - CLINICAL PHARMACY, and you use it to delineation of clinical privileges - clinical pharmacy. Second, check the edition: the copy offered here is dated 02/01/2004 and its publication status is ACTIVE. Third, size up the job — 3 page(s) and about unknown entry fields, so you can decide whether to fill it now or set aside time. One thing to settle first: a later edition has been issued. Reach for this one only when you are working with a record already executed on it.
Then work out your role. If the entries describe you, you fill them in and someone in the administrative section checks the result. If you handle records for others, you enter what they supply and pass the form along. In both cases the same two references govern you: TSG maintains the form, and AR 40-68 sets out the trigger for using it and the route it takes. Read that directive before you start when anything about your case is unusual.
Start at the top of the page and work down. The heading blocks come first: write your name as it appears on your official records, then your identification number, then your unit or organisation, then the date you are preparing the form. Do not skip ahead to the interesting parts and come back — these heading entries are how your form is found in the file afterwards, and a form filed under a misspelled name is a form nobody can locate.
In the body of the form, tab from field to field instead of clicking around. The tab order follows how the form was constructed, which keeps you from missing a box. For check boxes and option buttons, click them. If you find a set where the choices are exclusive, expect your new selection to clear the previous one. Keep an eye on long entries as you type: fields built for one line will not wrap, and what overflows the width will print truncated even though your screen shows all of it. At that point move the text into remarks or onto a continuation. And when something does not apply to you, say so in the field — write the entry that means "none" rather than leaving white space a reviewer has to interpret.
Leave the signature until everything else is done. Sign by hand or by an approved electronic means, and remember that a form without a signature is a draft, however complete the entries. Where a second and third signature are required — reviewing official, approving authority, witness — go in the order the blocks appear, and each signer dates the form on the day of signing. Then go back to the top and read what you wrote. Look first for a mandatory field you passed over, then for transposed digits in your identification number, then for a date with the day and month inverted. If you started from a file you had used before, look also for entries left from that earlier use; nothing removes them but you.
Read the Privacy Act statement when it appears on the page, before you fill in the personal details it covers. It sets out the authority for collecting the information, the purpose behind it, the routine uses it may be put to, and whether your disclosure is required or voluntary. Then keep in mind what you have created — a completed copy carries personal data, and you handle and store it under the rules that apply to such records.
Download the form
Now pick your file. You have PDF, XFDL to choose from, and the choice depends on one thing: whether you will type the entries or write them by hand. Choose the fillable pdf when you want to type, tab between fields and keep a clean copy on your computer. Choose the printable pdf when you intend to print the blank first and write on paper. The pages look identical either way, so you are not giving anything up by picking the wrong one — you are only choosing how you work.
After you download, open the file the right way. Double-click a pdf and your browser may take it, which is fine for reading but risky for filling: some browser viewers show you the fields, let you type, and then lose the text when you close the tab. Save the file to your computer first, then open it in a full pdf reader, and check that your entries survive a save before you type the whole form. If you downloaded the xfdl file, do not try a pdf reader on it. That format is IBM Lotus Forms, and you need the Lotus Forms Viewer to open it at all.
Finally, note what the download costs you: nothing. You do not create an account, you do not enter an email address, and the file you receive is the published document with nothing added to it.
Now send it on. Follow the routing in the prescribing directive, which will point you to a named office, to your unit administrative channel, or to your own file. Take a copy before you release it. From there the record follows the retention schedule for the series, and neither you nor the receiving clerk shortens or extends that on local judgement.
Should the package need more than one document, 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 a form referenced on the page you are filling usually accompanies it. Collect the continuations, covers and transmittals up front so the submission goes complete the first time.
Before you reuse a saved copy, look at the edition date printed on it. The proponent revises the form from time to time, and your stored file will not tell you when that happens — you compare its date against the current edition yourself. If a revision has come out since you last filed one of these, leave the earlier submission alone; the change does not reach backwards.
Finally, know where you are. These are copies of published Department of the Army forms, made available for you to download. The site is independent, unconnected to the Department of the Army, and in no position to issue forms or to promise that any office will accept yours. None of this is legal advice. If a specific entry puzzles you, if you are unsure a requirement applies, or if eligibility is in question, put the question to TSG or to the administrative office serving your unit.
Questions and answers
- What is DA Form 5440-38?
- DELINEATION OF CLINICAL PRIVILEGES - CLINICAL PHARMACY
- 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