You need DA Form 5440-58, and this page gets you to the file and through it. Start with what the form is: DELINEATION OF CLINICAL PRIVILEGES - SUBSTANCE ABUSE REHABILITATION, used to delineation of clinical privileges - substance abuse rehabilitation. Check next that you have the right version — the edition dated 02/01/2004 is the one published here, and its status is ACTIVE. Then look at the size before you begin, because 2 page(s) and roughly unknown fields tell you how long this will take. Before you go further, note that a newer edition exists. Use this one only if you are looking at a record already completed 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.
You will find a Privacy Act statement on the form wherever personal information is collected. Read it at that point rather than skipping past it, because it tells you the authority for the collection, the purpose, the routine uses, and whether answering is mandatory. After you fill the form, remember that your copy contains personal data. Store it and transmit it as your office requires for records of that kind.
Download the form
Next comes the download itself. The formats available are PDF, XFDL, and you decide between them by asking how you will enter the information. If you plan to type, take the fillable pdf: the boxes accept keyboard input and you can save the result. If you plan to write by hand, take the printable pdf and run it through your printer while it is still blank. Both show the same published page, so the decision affects your method and nothing else.
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.
One last point before you move on: every format is free. No registration stands between you and the file, and what you download is the published form, unaltered.
With the form signed, send it where AR 40-68 tells you to send it — usually to the office it names, or through your unit administrative channel, or straight into your own record, depending on why you raised it. Keep a copy for yourself before it leaves your hands. How long the receiving office holds it is not your decision or theirs; the records schedule for the series settles that, and local habit does not override it.
When another document has to travel with this one, find it by series and number. Forms in the DA series sharing a proponent or a governing directive are commonly used in combination, and anything cited on the face of your form generally goes with it. Assemble continuation sheets, covers and transmittals before you send the package rather than in response to a query.
Check the edition date again the next time you reach for this form. Editions change when the proponent revises the content, and a copy you saved months ago may no longer be current — compare the date printed on your file against the edition in force before you type anything into it. What you do not need to do is redo work already finished: a form you completed and submitted under an earlier edition stays as it is.
One last thing to be clear about before you download. What you get here is a copy of a published Department of the Army document. This site is not part of the Department of the Army, issues no forms of its own, and cannot tell you that any office will accept what you submit. Nothing written on this page is legal advice. When you are unsure about a particular entry, a requirement or whether you are eligible at all, ask TSG or the administrative office that services your unit — they answer those questions and we do not.
Questions and answers
- What is DA Form 5440-58?
- DELINEATION OF CLINICAL PRIVILEGES - SUBSTANCE ABUSE REHABILITATION
- 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,