Da form 5440-2025

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The document is the U.S. DOD Form dod-da-5440-38, which outlines the delineation of clinical privileges for clinical pharmacists. It provides instructions for providers and supervisors on how to request and approve specific clinical privileges related to pharmacy practice, including patient assessment, medication management, and participation in treatment protocols for various health conditions. The form emphasizes the qualifications required for clinical pharmacists and details the approval process involving signatures from both providers and supervisors.

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Click ‘Get Form’ to open DA Form 5440 in the editor.
Begin by entering the provider's name in the designated field, ensuring you include the last name, first name, and middle initial.
Next, fill in the rank/grade and facility information as required. This is crucial for proper identification.
In Section I, review each clinical privilege listed. Enter the appropriate provider code in the 'REQUESTED' column for each privilege you wish to apply for.
If any criteria do not apply, line through them and initial. Remember to sign at the end of Section I once completed.
For supervisors, review the requested privileges and enter approval codes in the 'APPROVED' column. Your signature is needed in Section II.
Finally, ensure all sections are filled accurately before saving or exporting your completed form for submission.

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2004	4.8 Satisfied (167 Votes)

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What is the 5500 form used for?

All Soldiers must still conduct a height and weight screening, and their data must be recorded on a Department of the Army Form 5500 or DA Form 5501. Soldiers who do not meet the height and weight standards but qualify for exemption will not be required to conduct a circumference-based tape assessment.

Do all soldiers need a 5500?

The unit member recording the measurements is responsible for signing the DA Form 5500 and DA Form 5501 in the prepared by block.

How to fill out the new DA form 5960?

0:22 2:17 In box 8 you must identify your marital. And dependency status including all current and previousMoreIn box 8 you must identify your marital. And dependency status including all current and previous marriages. And dependent.

What is a DA form 4833 used for?

DA Form 4833 is a document used by the U.S. Army to report the results of a military members investigation into an incident that has resulted in administrative punishment or disciplinary action.

What is DA form 5500 used for?

The DA Form 5500 is required for documenting the body fat of military personnel to ensure they meet the Armys physical fitness standards.

What is DA Form 5500?

The employer maintaining the plan or the plan administrator of a pension or welfare benefit plan covered by the (Employee Retirement Income Security Act) ERISA. File Form 5500 to report information on the qualification of the plan, its financial condition, investments and the operations of the plan.

How to fill out a DA form 5840?

How to fill out DA Form 5840? Fill in the blanks: Enter the guardians name, address, email, and notary information. Sign the form: The guardian must sign in the notarys presence. Date the form: Include the date of signing. docHub the form: Have the notary acknowledge and stamp the document.

Da form 5440-2025

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