DA Form 5440-19: Dietetics Clinical Privileges Guide – Are you a registered dietitian (RD) or aspiring military nutrition professional seeking clinical privileges in the U.S. Army? DA Form 5440-19, titled Delineation of Clinical Privileges – Dietetics, is the official document used to request, review, and grant specific clinical authorities for dietitians working in Army medical treatment facilities (MTFs).
This form ensures that dietitians practice within their demonstrated competence, training, and facility capabilities while supporting high-quality patient care under AR 40-68, Clinical Quality Management.
What Is DA Form 5440-19?
DA Form 5440-19 (February 2004 edition) standardizes the privileging process for dietetics providers. It outlines two main categories of privileges:
- Category I: Core/routine privileges expected of registered hospital dietitians. These include nutritional assessments, basic procedures, ordering certain diets and labs, and providing medical nutrition therapy (MNT) for various conditions.
- Category II: Advanced/special privileges (building on Category I) that require additional education, training, and expertise, such as ordering tube feedings or parenteral nutrition (with physician co-signature), teaching blood glucose monitoring, or conducting indirect calorimetry.
The form uses a standardized coding system for both the provider (REQUESTED) and supervisor (APPROVED):
| Code | Provider Meaning | Supervisor Meaning |
|---|---|---|
| 1 | Fully competent | Approved as fully competent |
| 2 | Modification requested | Modification required |
| 3 | Supervision requested | Supervision required |
| 4 | Not requested (lack of expertise) | Not approved (insufficient expertise) |
| 5 | Not requested (facility/mission) | Not approved (insufficient support) |
Download the official form here: DA Form 5440-19 PDF.
Key Privileges Outlined in DA Form 5440-19
Category I (Routine Privileges)
- Evaluation: Classify clinical nutrition category, recommend community referrals, evaluate diet orders, classify stages of change.
- Procedures: Anthropometric measurements, body composition, blood glucose monitoring.
- Orders: Diet orders per physician verbal direction, calorie adjustments, supplements, calorie counts, specific lab studies (albumin, prealbumin, glucose, HbA1c, lipids, etc.), vitamin/mineral supplements, referrals.
- Medical Nutrition Therapy (MNT): General and modified diets across life cycles (neonatal, pediatric, geriatric), cardiovascular, GI, renal, hepatic, diabetic, psychiatric, test diets, and nutrition support.
Category II (Advanced Privileges)
- Ordering tube feedings and parenteral formulas (per local policy and with co-signature).
- Teaching patients blood glucose monitoring.
- Conducting indirect calorimetry.
- Transitional feedings and other advanced interventions.
These privileges align with the scope of practice for registered dietitians, emphasizing evidence-based MNT while complying with Army, DoD, and accreditation standards (e.g., The Joint Commission).
Who Uses DA Form 5440-19?
- Army Dietitians (65C): Active duty, Reserve, National Guard, and civilian GS dietitians in MTFs.
- Supervisors: Department chiefs, credentials committees, and privileging authorities.
- Process: Providers request privileges; supervisors review and recommend; credentials committee/final approval by the commander. Privileges are typically reviewed biennially or with changes in assignment.
Requirements for Dietitians (per AR 40-68):
- Current registration with the Commission on Dietetic Registration (CDR).
- Active, unrestricted state license (where applicable).
- Documentation of education, training, and demonstrated competence.
Why Clinical Privileges Matter in the Army?
Privileging protects patients, supports provider accountability, and ensures dietitians contribute fully to interdisciplinary care teams. In military settings, this includes:
- Supporting Soldier readiness and performance nutrition.
- Managing inpatient/outpatient MNT for chronic conditions, wounds, or critical care.
- Contributing to wellness programs, field feeding, and humanitarian missions.
Accurate completion of DA Form 5440-19 is essential for credentialing, staff appointment, and avoiding gaps in practice authority.
Step-by-Step Guide to Completing DA Form 5440-19
- Provider Section: Fill in name, rank, facility. Request codes (1-5) for each privilege. Line through non-applicable items and attach justifications.
- Signature: Provider signs and dates Section I.
- Supervisor Review: Enter approval codes, recommendations, and signature.
- Credentials Committee: Final review and approval/disapproval.
- Retention: Maintain in credentials files per AR 40-68. Submit a new form for any changes.
Tip: Align requests with your training, experience, and the MTF’s mission. Consult your Nutrition Care Division chief or credentials manager.
Related Resources
- AR 40-68 Clinical Quality Management (with 2009 RAR) — Governs the entire privileging process.
- Army Medical Command (MEDCOM) guidance on dietitian roles.
- Commission on Dietetic Registration (CDR) for professional standards.
- U.S. Army-Baylor Master’s Program in Nutrition for career entry.
Frequently Asked Questions (FAQ)
Is DA Form 5440-19 still current?
Yes, it remains the prescribed form referenced in official Army publications.
Can civilian dietitians in Army facilities use it?
Yes, it applies to military, civilian, and contract providers.
How often must privileges be renewed?
Typically every two years, or with assignment changes.
For questions specific to your facility, contact your local Medical Staff Office or Credentials Committee.
Stay compliant and maximize your scope of practice with proper use of DA Form 5440-19. This form empowers Army dietitians to deliver critical nutrition care that supports mission readiness and optimal health outcomes for service members and their families.