Administrative documents are written for readers who were not present, and DA Form 5440-22 is no exception. Titled DELINEATION OF CLINICAL PRIVILEGES, it is used to delineation of clinical privileges — a transaction that means little in conversation and a great deal in a file. The published edition here carries the date 02/01/2004 and the status ACTIVE. Its 2 page(s) and roughly unknown fields are sized to what the record must prove years later, which is always more than the moment appears to need. A newer edition exists. This one is retained because the documents completed on it were completed under its terms and are read under them.
The form has an author and an occasion, held by different authorities. TSG owns the content and reshapes it when what is being recorded changes. AR 40-68 governs the event that calls for the form and the route the finished document takes afterwards. Keeping those two apart is what allows a procedure to be amended without the page being rebuilt each time.
Retrieval governs the order of entry. The head of the form takes name, identification number, unit and date, and those values become the handles by which the record is found later — the substantive blocks are never searched on. This is why the spelling must match official records exactly rather than approximately.
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.
Signing is the act that makes the document evidence, and until it happens the entries are only a proposal. Additional signatures — reviewer, approver, witness — each stand for a separate judgement, dated when applied so the record shows who accepted what and in what order. The common faults all damage that record in the same way: a blank mandatory field breaks the chain of required answers, swapped digits in an identification number detach the document from its subject, an inverted day and month misplaces it in time, and stale data from a reused copy states things nobody meant to state.
The Privacy Act statement is on the page because collecting personal information requires the collector to disclose the terms first — the authority relied on, the purpose, the routine uses, and whether an answer is required or may be withheld. That order is the point: the statement is read before the entries it governs, since consent given afterwards is not consent. Once completed, the copy is a personal record and carries the handling obligations that attach to one.
Download the form
Why several files for one page? Because the form has to be completed in a headquarters and in places without a workstation, and PDF, XFDL covers both. The fillable pdf holds interactive fields that fix each entry in place and remove handwriting from the equation. The printable pdf is the same layout without those fields, meant for a printer and a pen. Neither is a lesser copy of the other; each answers a condition the other cannot.
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.
There is no charge and no sign-up. Published documents are distributed as published, without modification.
The routing in AR 40-68 decides where the document goes — a named office, the administrative channel, or the individual's file — and the records schedule for the series decides how long it stays. Neither is a local judgement, because a record system loses its meaning if each office keeps things for its own preferred interval. Copy the form before submitting it.
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.
Revision follows the process, which is why editions appear without a fixed interval, and the printed date rather than any version number identifies them. Nothing on a stored copy signals that it has aged; the check is manual. Work already completed under a superseded edition stands as filed, because the record was made under those terms and is properly interpreted under them.
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 5440-22?
- DELINEATION OF CLINICAL PRIVILEGES
- 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,