DA Form 5440-37: Speech Pathology Privileges – Download PDF

DA Form 5440-37: Speech Pathology Privileges – Download PDF – Speech-language pathologists (SLPs) working in U.S. Army medical treatment facilities (MTFs) must obtain and maintain clinical privileges to provide high-quality, evidence-based care. DA Form 5440-37, titled Delineation of Clinical Privileges – Speech Pathology, is the official document used for this purpose.

This form ensures that SLPs practice within their verified competencies, aligning with Army standards for patient safety and quality care.

What Is DA Form 5440-37?

DA Form 5440-37 is a two-page U.S. Department of the Army form released on February 1, 2004. It falls under the series of DA Form 5440 documents used across medical specialties.

It allows speech pathologists to request specific clinical privileges based on their education, training, experience, and demonstrated competency. Supervisors review these requests, and a credentials committee or facility commander grants final approval.

The form is prescribed in AR 40-68, Clinical Quality Management (with updates), which governs privileging for non-physician health care providers, including speech pathologists.

Why Is This Form Important for Army SLPs?

  • Defines Scope of Practice: It lists procedures for assessment and treatment of speech, language, voice, fluency, swallowing (dysphagia), and related disorders in military beneficiaries (active duty, retirees, and dependents).
  • Ensures Competency: Privileges are granted only after verifying qualifications, such as a master’s or doctoral degree in speech-language pathology, Certificate of Clinical Competence (CCC-SLP) from ASHA, state licensure, and relevant military or clinical experience.
  • Supports Quality Management: Regular re-privileging (typically every two years) promotes ongoing professional development and compliance with Joint Commission and DoD standards.
  • Facility-Specific: Privileges align with the capabilities of the specific MTF, such as Womack Army Medical Center or other installations offering speech pathology services.

In military settings, SLPs often address TBI, voice disorders from deployment, pediatric developmental issues, and cognitive-communication deficits.

Key Sections of DA Form 5440-37

Typical structure (based on the 5440 series and form descriptions):

  1. Provider Information — Name, rank/grade, facility, and qualifications.
  2. Section I – Clinical Privileges — Categories of privileges with columns for “Requested” and “Approved” (often using codes like 1 = Fully competent).
    • General practice areas: Articulation/phonological disorders, voice disorders, fluency disorders, language disorders (infants/toddlers through adults), swallowing evaluations, cognitive-linguistic therapy, etc.
    • Diagnostic and therapeutic management.
  3. Specific Procedures — May include videofluoroscopic swallow studies (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), augmentative communication, and more (depending on facility protocols).
  4. Supervision and Recommendations — Supervisor review and signatures.
  5. Approval — Credentials committee or commander endorsement.

The form emphasizes that privileges must match the provider’s documented training and the MTF’s needs. Revisions require a new submission.

Download the Official DA Form 5440-37 Here:
https://armypubs.army.mil/pub/eforms/DR_a/pdf/A5440_37.pdf

How to Complete DA Form 5440-37? (Step-by-Step Tips)

  1. Gather Documentation — Resume/CV, transcripts, CCC-SLP certificate, state license, continuing education records, and prior privilege history.
  2. Request Privileges Realistically — Base requests on your actual experience. New providers may start with core privileges under supervision.
  3. Provider Codes — Typically mark “Requested” column (e.g., 1 for fully competent).
  4. Supervisor Input — Your department chief or senior SLP reviews and recommends approval levels.
  5. Submit to Credentials — Route through the MTF’s credentials office per local policy and AR 40-68.
  6. Biennial Renewal — Update with new DA Form 5440-37 or equivalent evaluation form (e.g., DA Form 5441-37 for evaluations).

Consult your facility’s Medical Staff Office or credentials coordinator for guidance, as processes may vary slightly by installation.

  • DA Form 5441-37 — Evaluation of Clinical Privileges – Speech Pathology (for performance reviews).
  • AR 40-68 — Primary regulation for clinical quality management and privileging.
  • Similar forms exist for audiology (DA Form 5440-36) and other allied health professions.

For Air Force or other services, equivalent forms (e.g., AF Form 3929) outline comparable speech pathologist privileges.

Qualifications for Army Speech Pathologists

To qualify for privileges:

  • Master’s or doctoral degree from a CAA-accredited program.
  • ASHA CCC-SLP.
  • Current state licensure (where applicable).
  • Military-specific training for unique populations (e.g., TBI, voice, swallowing in combat contexts).
  • Ongoing competency assessments.

Civilian SLPs working as GS employees in Army facilities also use this process.

Need Help with DA Form 5440-37?

Military SLPs, healthcare administrators, and providers in the U.S. Army Medical Command rely on accurate privileging to deliver essential rehabilitation services. Whether you’re a new hire, transferring facilities, or renewing privileges, proper use of DA Form 5440-37 ensures compliance and optimal patient care.

Official Download Link: DA Form 5440-37 PDF

For the latest guidance, visit Army Publishing Directorate (armypubs.army.mil) or contact your local MTF credentials office. Always reference current AR 40-68 for policy details.