DA Form 5440-47: Preventive Medicine Privileges Guide

DA Form 5440-47: Preventive Medicine Privileges Guide – DA Form 5440-47 is the official U.S. Army document used to request, review, and grant clinical privileges in Preventive Medicine. It ensures qualified physicians practice within their demonstrated competencies, supporting force health protection, public health, and operational readiness across military treatment facilities (MTFs).

What Is DA Form 5440-47?

Title: Delineation of Clinical Privileges – Preventive Medicine
Date: February 2004 (current version as referenced in official sources)
Proponent: Office of The Surgeon General (OTSG)
Governing Regulation: AR 40-68, Clinical Quality Management Program (CQMP)

This two-page form standardizes the privileging process for Preventive Medicine physicians. It categorizes privileges by training and experience levels and requires input from the provider, supervisor, and credentials committee.

Download the official PDF here: DA Form 5440-47

Note: Use it in conjunction with DA Form 5440-25 (General Medical Officer). Physicians also serving in Occupational Medicine should complete the corresponding Occupational Medicine form.

Purpose and Importance in the U.S. Army

Clinical privileging verifies that providers have the education, training, experience, and current competence to deliver safe care. For Preventive Medicine, this is critical for:

  • Preventing disease outbreaks in garrisons and deployed environments
  • Conducting epidemiological investigations
  • Ensuring compliance with public health regulations
  • Supporting deployment readiness and force health protection

Privileges are facility-specific and reviewed periodically. Recent Military Health System updates (as of 2025) streamline portability of privileges across MTFs, reducing administrative burden while maintaining standards.

Clinical Privilege Categories on DA Form 5440-47

Category I (Core Preventive Medicine Privileges)

Requires completion of the AMEDD 6A-F5 Course (Principles of Military Preventive Medicine) or a Master of Public Health (MPH) or equivalent degree.

Key Privileges Include:

  • Consultation and policy development for control of public health and operational diseases (vaccines, chemoprophylaxis, personal protection)
  • Diagnosis and treatment of outpatients with communicable diseases; interruption of transmission (immunization, isolation, contact tracing)
  • Population screening using health risk appraisals and non-invasive tests
  • Pre-deployment/travel medicine consultations and post-travel illness evaluation
  • Basic occupational medicine services (exams, minor injury care, worksite evaluations)
  • Disease/injury surveillance, basic epi investigations, and required reporting
  • Field preventive medicine support during training and deployments

Category I providers typically serve as installation or unit Preventive Medicine officers (up to division level).

Category II (Advanced Privileges)

Includes all Category I privileges. Requires physician residency training or board certification in General Preventive Medicine and Public Health (GPM-PH). Certification in Occupational or Aerospace Medicine with advanced training in epidemiology, communicable disease control, and public health may substitute.

Additional Privileges:

  • Liaison with civilian and higher military public health authorities
  • Supervision of environmental health services (sanitation, vector control, hazard monitoring)
  • Community health needs assessment and intervention programs
  • Advanced epidemiological studies, data analysis, and risk communication
  • Consultation to Category I providers
  • Public health aspects of nuclear, chemical, and biological (CBRN) preparedness (with specific competency documentation)

Category II providers often serve as Chiefs of Preventive Medicine Services or staff officers at corps level and above.

How to Complete DA Form 5440-47?

  1. Provider Section — Enter codes (1-5) for requested privileges.
  2. Supervisor Review — Approves or modifies with justification.
  3. Credentials Committee — Final recommendation to the commander (approval authority).

Provider Codes (and matching Supervisor Codes):

  • 1: Fully competent
  • 2: Modification requested
  • 3: Supervision requested
  • 4: Not requested (lack of expertise)
  • 5: Not requested (facility/mission limitations)

Document any modifications or special competencies. Sign and date appropriately.

Who Needs This Form?

  • Army Preventive Medicine physicians (MDs/DOs)
  • Providers transitioning roles or facilities
  • Those seeking initial or renewed privileges in MTFs, deployed settings, or Reserve/Guard components
  • AR 40-68: Full guidance on the Army Clinical Quality Management Program.
  • Military Health System Privileging: Streamlined processes for portability (2025 updates).
  • Complementary forms: DA 5440 series for other specialties (e.g., Occupational Medicine, Aerospace Medicine).
  • Board certification through the American Board of Preventive Medicine (ABPM) strengthens applications for higher categories.

Pro Tip for Applicants: Maintain a robust portfolio of training certificates, deployment experience, MPH/residency documentation, and performance evaluations. Current competence demonstrations (e.g., via proctoring or case logs) are essential.

DA Form 5440-47 plays a vital role in maintaining high standards of preventive health care in the U.S. Army. By clearly delineating privileges based on training and experience, it protects patients, supports mission readiness, and ensures Preventive Medicine specialists can effectively safeguard the health of service members and their families.

For the most current guidance, consult your local Medical Treatment Facility credentials office or the latest AR 40-68. Always use official Army Publishing Directorate sources for forms and regulations.