DA Form 5440-28: Clinical Privileges – Social Work Guide

DA Form 5440-28: Clinical Privileges – Social Work Guide – Military social workers play a critical role in supporting Soldiers, Families, and communities through the U.S. Army’s Medical Treatment Facilities (MTFs). One essential document in this process is DA Form 5440-28, officially titled Delineation of Clinical Privileges – Social Work.

This form standardizes the granting of clinical privileges to qualified social work professionals, ensuring they deliver safe, competent, and mission-aligned behavioral health services.

What Is DA Form 5440-28?

DA Form 5440-28 is a Department of the Army form used to request, review, and approve specific clinical privileges for social workers practicing in Army healthcare settings. It falls under AR 40-68, Clinical Quality Management (with the proponent agency being the Office of The Surgeon General, OTSG).

The form helps define the scope of practice based on the provider’s education, licensure, training, experience, and facility needs. It covers assessment, diagnosis, treatment, case management, and specialized interventions, particularly in areas like Family Advocacy Program (FAP) support.

Key Details:

  • Date of Form: February 2004 (current version; previous editions obsolete).
  • Download: Official PDF available from Army Publishing Directorate → https://armypubs.army.mil/pub/eforms/DR_a/pdf/A5440_28.pdf.
  • Purpose: Ensures only competent, privileged providers deliver independent or supervised care.

Who Uses DA Form 5440-28?

This form applies to:

  • Active Duty Army social workers (military occupational specialty 73A).
  • Civilian GS social workers in Army MTFs.
  • Contract or other authorized providers delivering behavioral health services.

It is particularly relevant for Licensed Clinical Social Workers (LCSWs) involved in inpatient/outpatient care, command-directed evaluations, substance abuse programs, and FAP cases involving child/spouse abuse, neglect, or domestic violence.

Clinical Privilege Categories on DA Form 5440-28

The form organizes privileges into three main categories, with detailed sub-privileges that providers must request and supervisors approve using specific codes.

Provider and Supervisor Codes (1-5 scale):

  • 1: Fully competent / Approved as fully competent.
  • 2: Modification requested/required.
  • 3: Supervision requested/required.
  • 4-5: Not requested or not approved due to expertise or facility limitations.

Category I: MSW degree (not yet licensed). Provides services under supervision while pursuing licensure.

Category II: MSW/DSW/PhD + licensed Social Worker. Independent practice (with Chief, Social Work Service approval) for assessment, diagnosis, treatment, etc.

Category III: Advanced licensed Clinical Social Worker with specialized skills + minimum 12 years experience. Highest level of independent practice.

Core Privileges Include:

  • Psychosocial assessments (individual, group, family, marital, child/spouse/elder abuse, sexual abuse, etc.).
  • DSM diagnosis.
  • Inpatient/outpatient treatment (individual, group, family, child/adolescent therapy, substance abuse, sexual dysfunction/offender treatment*).
  • Case management (Family Advocacy, discharge planning).
  • Command-directed behavioral health evaluations.
  • Referrals (home health, adoption, foster care, etc.).

Specialized areas (marked with ) require documented training and supervised experience.

Step-by-Step Process for Completing DA Form 5440-28

  1. Provider Section (Section I): Fill in name, rank/grade, facility. Request privileges by coding each item.
  2. Supervisor Review: Chief or designee reviews and codes approvals.
  3. Credentials Committee: Final recommendation and approval by the MTF Commander or designee.
  4. Revisions: Any changes require a new form submission.

The process aligns with Army credentialing standards to maintain high-quality care and compliance with DoD policies.

Why Clinical Privileging Matters in Army Social Work?

Privileging protects patients, supports providers, and ensures compliance with regulations like AR 40-68 and DoD directives on Family Advocacy and behavioral health. It directly impacts readiness by enabling social workers to address mental health, family issues, deployment stress, and trauma effectively.

For Army social workers pursuing commissioning or advancing careers, understanding and properly using this form is a key professional milestone.

How to Download and Prepare DA Form 5440-28?

  • Visit the official Army link above for the fillable PDF.
  • Ensure supporting documentation (licenses, training certificates, experience logs) is ready.
  • Consult your local MTF Social Work Service Chief or Credentials Manager for guidance specific to your facility.

Note: Always verify the latest guidance through official Army channels, as policies can evolve with new DoD or DHA updates.

  • AR 40-68: Clinical Quality Management.
  • Army Family Advocacy Program (AR 608-18).
  • GoArmy.com career information for 73A Social Worker.

If you are an Army social worker, supervisor, or administrator preparing for credentialing, DA Form 5440-28 is your foundational tool for authorized practice. Download it today and ensure your privileges align with your expertise and the Army’s mission.