DA Form 5440-32: Dermatology Clinical Privileges Guide

DA Form 5440-32: Dermatology Clinical Privileges Guide – Military dermatologists and credentialed providers in the US Army rely on DA Form 5440-32 to formally request, document, and approve specific clinical privileges in dermatology. This standardized form ensures that only qualified providers perform dermatologic procedures, aligning with patient safety, regulatory compliance, and the standards outlined in AR 40-68 (Clinical Quality Management).

What Is DA Form 5440-32?

DA Form 5440-32, titled Delineation of Clinical Privileges – Dermatology, is an official US Army form (dated FEB 2004) used by dermatology providers to request privileges at military treatment facilities (MTFs). It is part of the Army’s credentialing process managed by the Office of The Surgeon General (OTSG).

The form divides privileges into two main parts:

  • Part I (Core/Basic Privileges): Fundamental skills such as history & physical examination, KOH preparation & interpretation, oil preparation for scabies, Tzanck preparation for herpes, local anesthesia, and punch biopsy.
  • Part II (Advanced/Specialty Privileges): More complex procedures including incisional & excisional skin biopsy, cryosurgery, ablative cutaneous surgery (cold knife, electrocoagulation, etc.), phototherapy (UVB, UVA, PUVA), patch testing, dermabrasion, chemical peels, laser therapy, Mohs micrographic surgery, grafts, flaps, sclerotherapy, and interpretation of immunofluorescence.

Providers use a coding system (1–5) to indicate requests (e.g., fully competent, modification requested, or not requested). Supervisors and credentials committees then approve or modify using corresponding codes.

Who Uses DA Form 5440-32?

  • Board-certified or board-eligible dermatologists in the US Army.
  • Other qualified providers seeking dermatology-specific privileges.
  • Medical facilities for initial credentialing, renewal, or modification of privileges.

It supports high-quality, scope-of-practice-aligned care in military settings, where providers may handle a wide range of skin conditions, including those related to deployment, environmental exposures, and routine dermatologic needs.

Why Proper Delineation of Privileges Matters?

Accurate completion of DA Form 5440-32:

  • Ensures compliance with Army Regulation 40-68.
  • Supports quality patient care by matching provider competence to procedures.
  • Facilitates credentialing reviews and Joint Commission-aligned standards.
  • Allows for tailored privileges based on training, experience, and facility capabilities (e.g., laser equipment availability).

Privileges typically require documentation of training (e.g., ACGME-accredited residency in dermatology), board certification (American Board of Dermatology), and recent clinical experience.

How to Complete DA Form 5440-32?

  1. Provider Section: Enter name, rank, facility. For each privilege, mark the appropriate code in the “REQUESTED” column. Line through and initial non-applicable items.
  2. Supervisor Review: The supervisor reviews and marks the “APPROVED” column.
  3. Signatures: Provider signs Section I. Supervisor, Department/Service Chief, and Credentials Committee provide recommendations in Sections II and III.
  4. Documentation: Attach proof of training, proctoring records, or case logs as needed for advanced procedures like Mohs surgery or laser therapy.
  5. Updates: Submit a new form for any changes to privileges.

Download the Official DA Form 5440-32 PDF:
https://armypubs.army.mil/pub/eforms/DR_a/pdf/A5440_32.pdf

  • Other DA Form 5440 series for different specialties (e.g., Physician Assistant, General Medical Officer).
  • AR 40-68 for full credentialing guidance.
  • Facility-specific privilege lists and Medical Staff Bylaws.

Tips for US Army Dermatology Providers

  • Review your current competency and recent procedure volumes before requesting advanced privileges (e.g., laser, Mohs, or flaps).
  • Coordinate with your credentials coordinator early in the process.
  • Maintain detailed logs for renewal applications (typically every 2 years).
  • Stay current with evolving dermatology standards, including teledermatology, biologics, and cosmetic procedures relevant to military populations.

Note: This article provides general information based on publicly available Army publications and is not official legal or medical advice. Always consult your local Medical Treatment Facility credentials office, the proponent agency (OTSG), or current AR 40-68 for the most authoritative guidance. Forms and regulations can be updated; verify the latest version on official Army Publishing Directorate sites.

For dermatologists transitioning or seeking information on civilian equivalents, many hospitals use similar delineation-of-privileges documents tailored to their medical staff bylaws.