The reason DA Form 5440-1 looks the way it does is that a file has to speak for itself. Officially DELINEATION OF CLINICAL PRIVILEGES-DENTISTRY, it serves to delineation of clinical privileges-dentistry, and the record it produces outlasts the people and the circumstances behind it. Edition 02/01/2004, status ACTIVE, is the version published here: 2 page(s), close to unknown fields, each one present because some later reader will need that fact without being able to ask for it. Because a subsequent edition has appeared, this copy stays available — a record made under one edition is interpreted under that edition.
Two offices stand behind the form, and the distinction between them explains most of what follows. TSG is the proponent: it decides what the form asks and revises it when the underlying process changes. AR 40-68 is the prescribing authority: it decides when the form is raised at all and where the completed document travels. Content and occasion are separated deliberately, so that a change in procedure does not require redesigning the page.
Identification precedes substance for a structural reason. Name, identification number, organisation and date of preparation are how the finished document is located in a file or a database; the body of the form is what someone reads after the search has succeeded. Spell the name as official records spell it, since the search runs against those records and not against habit.
Tab order is not a convenience feature; it was fixed when the form was built and generally traces the page, so following it produces the sequence the designer intended and leaves fewer gaps than a mouse. Exclusive option groups clear the previous selection because the record is not permitted to hold two contradictory answers. Single-line fields do not wrap for the same reason the layout is fixed: the printed page has to fall in known positions, so text past the field width is cut at the margin even though the screen still shows it whole. Overflow belongs in remarks or on a continuation, where there is room designed for it. And an inapplicable field is marked rather than skipped, since a blank tells a later reader nothing about whether the question was considered.
A signature is what converts entries into a record, which is why it comes last and why an unsigned form remains a draft however complete it looks. Where a reviewing official, an approving authority or a witness also signs, each adds a distinct attestation, and each dates the day of signing rather than the day of preparation — the dates trace the sequence of responsibility. The recurring defects are worth knowing precisely because they defeat that purpose: an empty mandatory field leaves an obligation unmet, transposed identification digits attach the record to nobody, a date with day and month reversed puts events in the wrong order, and entries left in a reused working copy assert facts nobody intended.
Behind the Privacy Act statement is a requirement that anyone asked for personal data be told, in advance, under what authority it is sought, for what purpose, who else routinely sees it, and whether refusal is possible. Reading it after completing the fields defeats its function. And the completed form is itself a personal record from that point on, subject to the handling rules such records carry.
Download the form
Formats exist because completion happens under different conditions, not because anyone wanted variety. The published set is PDF, XFDL. A fillable pdf carries live entry objects, so typed text lands in fixed positions and stays legible whoever reads it later. A printable pdf drops those objects and leaves the page as an image, which is what an office needs where a screen is unavailable and a pen is not. The document itself is unchanged between them; what differs is the circumstance each anticipates.
Where a file opens matters more than it appears to. A browser will display a pdf, but browser viewers were built to read documents, and some accept keystrokes into fields they never intended to store — the entries are gone at tab close, without warning, because saving was never part of what that viewer does. A dedicated reader is built around the file's own structure and keeps what you enter. The xfdl file belongs to a different lineage entirely: IBM Lotus Forms, adopted across Army systems for the routing and signature handling built into it. That is why only the Lotus Forms Viewer reads it.
Downloads are free and unregistered. The material was published for general use, and the files are passed on unaltered.
Disposition is prescribed, not chosen. AR 40-68 names the destination, whether that is a specific office, the unit administrative channel or the personal record, and the applicable records schedule governs how long it survives there. Both rules exist to keep the file consistent across offices with different habits. Take your copy before the document leaves, since it will not come back.
Related documents are located by series and number, and the relation is rarely accidental — forms under one proponent or one directive tend to serve steps of a single procedure. Anything the DA series form names on its face normally travels with it, as do the continuations, covers and transmittals the process generates. Assembling them together is what makes the submission a complete account.
Editions change because the process changes, and the printed edition date is the only marker of which version a page belongs to. A copy saved locally cannot know it has been superseded, so the date on it is compared against the edition in force before reuse. Records already executed under an earlier edition are left alone — a document is read under the terms it was made, and reopening completed files to match a later form would falsify the account.
It is worth being plain about what this page is within all of the above. The files are reproductions of published Department of the Army documents, offered for download by a site with no official standing and no part in issuing anything. That matters because the machinery described here — proponency, prescribing directives, records schedules — runs entirely elsewhere. Nothing written here is legal advice, and no statement can be made about whether an office will accept a given document. TSG and the administrative office servicing your unit answer questions of entry, requirement and eligibility, and they are the ones positioned to.
Questions and answers
- What is DA Form 5440-1?
- DELINEATION OF CLINICAL PRIVILEGES-DENTISTRY
- 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,