Da Form 5440 18 – Fill Out and Use This PDF

Da Form 5440 18 PDF Details

The DA Form 5440-18, titled "Delineation of Clinical Privileges - Physician Assistant," is a critical document within the U.S. Army medical system. It is governed by Army Regulation 40-68 (Clinical Quality Management), with oversight by the Office of The Surgeon General (OTSG). The form provides a formal process for physician assistants (PAs) to request and obtain clinical privileges, confirming their competence across primary care, specialty areas, procedures, and inpatient services.

Who Needs DA Form 5440-18?

This form is required for any physician assistant working within a U.S. Army medical treatment facility (MTF) who seeks authorization to perform specific clinical duties. It applies to:

• New PAs joining a military treatment facility for the first time
• PAs changing duty stations who need privileges at the new MTF
• PAs requesting expanded or additional privileges beyond their current scope
• PAs undergoing the standard credentialing renewal cycle

The form ensures every PA's scope of practice is formally documented, reviewed by a supervisor, and approved before any patient care begins.

Clinical Privilege Categories Covered

DA Form 5440-18 organizes clinical privileges into four broad categories, each requiring documented evidence of competency:

• Ambulatory care - Outpatient management of low-acuity patients, chronic disease management, and preventive care services
• Specialty services - Procedures requiring specialized training such as dermatology, orthopedic care, and emergency medicine skills
• Inpatient care - Hospital-based services including admission workups, patient management, and discharge planning
• Procedural competencies - Specific skills such as suturing, joint injections, IV catheter placement, nasogastric tube insertion, and first assist in major surgical cases

The Approval Process

Obtaining clinical privileges through this form involves a structured, multi-step review:

1. The PA completes the privilege request section, listing each privilege sought and providing documented evidence of training, case volume, and competency for each item
2. A supervising physician or department chief reviews all requests, confirms or modifies each privilege based on direct observation and performance records, and signs the review section
3. The credentials committee examines the completed form and may request additional documentation, a proctoring period, or direct observation before making a final decision
4. Final approval is granted by the facility commander or designated authority, typically within 30 to 60 days of a complete submission

PAs may be granted temporary privileges during the credentialing review period, allowing supervised patient care to continue without interruption while the full process is completed.

Governing Regulations and Record Requirements

The form is governed by Army Regulation 40-68, which establishes credentialing and privileging requirements for all Army healthcare providers. OTSG provides policy oversight to ensure consistency across all military treatment facilities worldwide. Facilities must retain completed DA Form 5440-18 records for each PA for the duration of the provider's assignment, plus a minimum of two years after separation from the facility.