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DA Form 5440-43 is a Department of the Army form in the DA series. Title of record: DELINEATION OF CLINICAL PRIVILEGES - OPHTHALMOLOGY. Function: delineation of clinical privileges - ophthalmology. The edition presently published bears the date 02/01/2004, with a status of ACTIVE. Physical extent is 2 page(s) and about unknown fillable fields.
Proponency for the form rests with TSG. The governing authority is AR 40-68, which establishes the circumstances of use and the required routing. Preparation falls to the individual named in the entries or to the unit administrator acting on that individual's behalf; review and signature follow the chain set out in the governing authority. A later edition of this form exists. The edition shown here is superseded and is retained for reference and for records already executed on it.
Formats offered: PDF, XFDL. All are the same published layout in different containers, and the choice between them is a matter of how the entries will be made rather than what appears on the page. The pdf serves as the authoritative rendering. A fillable pdf exposes editable fields on screen; a printable pdf is the blank form as a flat page for handwriting.
A pdf opens in any current browser or in a dedicated reader. Fillable behaviour is more reliable in a full reader than in a browser viewer, where some field types render but do not save. An xfdl file is also published. This is the IBM Lotus Forms format used within Army systems; it requires the Lotus Forms Viewer and will not open in a pdf reader or a word processor.
All formats are free to download and no registration is involved. The files are the published documents, distributed unmodified.
The blocks are worked through in the order they appear on the sheet. At the head sit the identifying entries: name, identification number, unit, date. Because the filed record is indexed on these, they precede everything substantive.
Fillable fields accept typing directly. Tab advances from one field to the next in the order the form was built, which is normally the reading order of the page. Check boxes and option buttons are clicked; where a set of options is exclusive, selecting one clears the rest. Fields sized for a single line will not wrap, and text exceeding the width is truncated in print even where it remains visible on screen. Long entries belong in the remarks area or on a continuation, not compressed into a narrow field.
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Disposition of the completed document follows the prescribing authority — delivery to the office it names, transmission through the unit administrative channel, or placement in the individual's record, according to circumstance. The preparer keeps a copy. Retention is governed by the applicable records schedule, not by office custom.
Associated documents are located through the series and number scheme. Forms in the DA series with the same proponent or the same prescribing directive tend to be used as a set, and any form named on the face of another normally accompanies it. Continuations, cover sheets, and transmittals fall into this category and are gathered before the package is sent.
An edition stands until the proponent issues a revision. The printed edition date identifies the version, and a copy held locally is checked against the edition now in force before reuse. Prior executions under a superseded edition are not reopened for that reason.
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Questions and answers
- What is DA Form 5440-43?
- DELINEATION OF CLINICAL PRIVILEGES - OPHTHALMOLOGY
- 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