First, confirm you are on the right form. DA Form 5440-54 carries the official title DELINEATION OF CLINICAL PRIVILEGES - THORACIC SURGERY, and you use it to delineation of clinical privileges - thoracic surgery. Second, check the edition: the copy offered here is dated 02/01/2004 and its publication status is ACTIVE. Third, size up the job — 2 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.
Next, find out whether you are the one who fills it. In most cases you complete the entries yourself, and an administrator in your unit reviews what you wrote before it moves on. If you are the administrator, you will be working from what the individual gives you. Either way, TSG owns the form and AR 40-68 tells you when to raise it and where it goes afterward, so read the directive first if your situation is not routine.
Work from the top down, one block at a time. First the name — copy it from your official records rather than writing it the way you usually do. Then the identification number, then the unit, then today's date. Fill these before anything else. When the form reaches a file cabinet or a database, these are the entries someone searches on, so get them right before you worry about the rest.
Now for the body. Use tab to advance through the fields; the order was set when the form was built and following it keeps you from leaving gaps. Check boxes and option buttons take a click. Where the options are mutually exclusive, choosing one will clear another, which is how the group is meant to behave. As you type longer entries, watch the field edge. One-line fields do not wrap, and anything past the edge prints missing even when you can still read it on screen — when that happens, put the text in remarks or on a continuation sheet. Leave nothing blank because it does not apply; enter the mark that means it does not apply, so the reviewer knows you read the question.
Sign at the end and not before. Use ink or the electronic method your office accepts; whatever the state of the entries, an unsigned form is still a draft. When a reviewer, approver or witness has to sign as well, collect those signatures in printed block order and make sure each one is dated the day it was applied, not the day you started. Then read the form through once from the beginning. Three faults account for most rejections: a required field left blank, an identification number with two digits swapped, and a date whose day and month are reversed. Add a fourth if you began from an old working copy — data left over from the last time will travel forward untouched.
At some point while filling the form you will meet a Privacy Act statement, and you should read it when you reach it rather than after you finish. It tells you who is authorised to collect the information, what it will be used for, who else may see it, and whether you are obliged to answer or may decline. Once you have entered your details, treat the file accordingly: it now holds personal information about you, so store it and send it the way your office handles 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.
Then take care with how you open what you downloaded. Your browser will happily display a pdf, and for reading that is enough — but for typing it is not, because some in-browser viewers accept keystrokes and then throw them away when the tab closes. Put the file somewhere on disk, open it in a proper reader, type into one field and save, and confirm the text is still there when you reopen. If you picked up the xfdl copy, get the IBM Lotus Forms Viewer before you go any further, because nothing else will open the file.
Then simply download. There is no charge, no sign-up and no email to hand over, and the file that arrives is exactly what the publisher released.
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.
If you find you need a second form to go with this one, look by series and number. Forms in the DA series that share a proponent or a prescribing directive are often used together, and any form named on the face of this one normally goes forward with it. Gather continuation sheets, cover sheets and transmittal documents before you submit, not after somebody asks for them.
The next time you open this form from your own files, check the edition date first. Revisions come from the proponent without warning to you, so the only reliable step is to hold your copy against the current edition before filling it in again. Records you already completed under a superseded edition stand, and you do not go back to rework them.
Read this before you go. The file you download is a reproduction of a published Department of the Army document, offered as it was published. We are an independent site with no connection to the Department of the Army and no authority to issue anything, and we make no statement about whether your completed form will be accepted anywhere. Treat what you read here as information, not legal advice. Take real questions — about an entry, a requirement, or your eligibility — to TSG or to your servicing administrative office.
Questions and answers
- What is DA Form 5440-54?
- DELINEATION OF CLINICAL PRIVILEGES - THORACIC SURGERY
- 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)