DA Form 5440-14: Nurse Anesthetist Privileges Guide 2026

DA Form 5440-14: Nurse Anesthetist Privileges Guide 2026 – Nurse anesthetists play a critical role in US military healthcare, delivering safe anesthesia care to Soldiers, families, and beneficiaries. DA Form 5440-14, titled Delineation of Clinical Privileges – Nurse Anesthetist, is the official US Army document used to request, review, and grant specific clinical privileges to Certified Registered Nurse Anesthetists (CRNAs).

This form ensures that CRNAs practice within their demonstrated competencies, in compliance with AR 40-68 (Clinical Quality Management).

What Is DA Form 5440-14?

DA Form 5440-14 is a standardized Army form (February 2004 edition, still current as of 2026) for delineating clinical privileges for nurse anesthetists in Army medical treatment facilities (MTFs).

It aligns with federal standards, state licensure requirements, and Department of Defense policies for privileging non-physician providers. The form helps credentialing bodies verify that CRNAs can safely perform anesthesia-related procedures based on training, experience, and current competence.

Official Download: DA Form 5440-14 PDF from Army Publishing Directorate.

Purpose of the Form

  • Defines the exact scope of practice for individual CRNAs.
  • Supports initial appointment, renewal, or modification of privileges.
  • Facilitates peer review and commander approval.
  • Ensures patient safety by matching privileges to verified skills.
  • Complies with The Joint Commission, DOD, and Army quality management standards.

Privileges are not automatic; they require documentation of education, certification, experience, and ongoing competency.

Key Sections of DA Form 5440-14

The two-page form includes:

Section I: Provider Information and Requested Privileges

  • Provider name, rank/grade, facility.
  • Provider Codes (1-5): Requested privileges coded as:
    • 1: Fully competent
    • 2: Modification requested
    • 3: Supervision requested
    • 4: Not requested (lack of expertise)
    • 5: Not requested (facility/mission limitations)

Core Privileges Listed (examples from the form):

  • Obtain health history (psychosocial and biophysical).
  • Conduct physical examination and assessment.
  • Establish anesthetic plan and determine patient suitability.
  • Obtain informed consent for anesthesia.
  • Prescribe/administer approved medications and treatments.
  • Insert IV catheters (including central lines via various routes), arterial catheters, and pulmonary artery catheters.
  • Use physiologic monitoring devices.
  • Administer general, regional (spinal, epidural, etc.), local, and sedation anesthesia.
  • Perform intubation/extubation.
  • Manage emergencies, fluid/electrolyte balance, pain, and post-anesthesia care.
  • Discharge from PACU and provide follow-up.
  • Initiate CPR/ACLS and manage ventilatory care.

Section II: Supervisor’s Recommendation
Supervisor (often an anesthesiologist or service chief) reviews and codes approvals.

Section III: Credentials Committee/Function Recommendation
Final recommendation and signatures from department chief and committee chairperson.

Comments sections allow for modifications or justifications.

Who Uses DA Form 5440-14?

  • Active Duty, Reserve, or civilian CRNAs in Army facilities.
  • US Army Graduate Program in Nurse Anesthesia (USAGPAN) graduates and other qualified providers.
  • Medical staff services, credentials committees, and commanders at Army hospitals and clinics.

Similar forms exist for other providers (e.g., DA Form 5440 series for various specialties).

Requirements for CRNA Privileges in the Army

To request privileges via this form, providers typically need:

  • Current RN license (unrestricted, any US state/territory).
  • Graduation from a COA-accredited nurse anesthesia program.
  • National certification (NBCRNA/CRNA).
  • Relevant clinical experience (e.g., critical care background).
  • Current BLS, ACLS, PALS as applicable.
  • Documentation of continuing education and recent case logs.

Privileges are reviewed periodically (often every 2 years) and must reflect current competence.

How to Complete DA Form 5440-14?

  1. Provider fills personal info and codes requested privileges.
  2. Line through inapplicable items and initial.
  3. Attach supporting documentation (e.g., training certificates, case logs).
  4. Supervisor reviews and recommends.
  5. Submit to Credentials Committee for final approval.
  6. Any changes require a new form.

Tip: Use the latest fillable PDF from armypubs.army.mil for accuracy.

Why Proper Privileging Matters?

Accurate delineation protects patients, supports mission readiness, reduces liability, and ensures CRNAs can fully utilize their advanced training in perioperative, pain management, and critical care settings. In the Army, this directly impacts surgical capabilities worldwide.

For civilian CRNAs transitioning to or working with military facilities, understanding this form is essential for credentialing alignment.

  • AR 40-68: Clinical Quality Management (governs the process).
  • Army Nurse Corps opportunities for CRNAs (66F MOS).
  • NBCRNA for certification maintenance.
  • Local MTF Medical Staff Office for facility-specific guidance.

Download the Form Here: Official DA Form 5440-14 PDF