DA Form 5440-48: Oral & Maxillofacial Surgery Privileges

DA Form 5440-48: Oral & Maxillofacial Surgery Privileges – DA Form 5440-48: Delineation of Clinical Privileges – Oral & Maxillofacial Surgery is a key U.S. Army document used to request, review, and grant specific clinical privileges for Oral and Maxillofacial Surgeons (OMS) practicing in military treatment facilities (MTFs).

This form ensures that providers practice only within their verified training, experience, and competency, aligning with Army Regulation (AR) 40-68, Clinical Quality Management.

What Is DA Form 5440-48?

DA Form 5440-48, dated February 2004 (with previous editions obsolete), is titled “Delineation of Clinical Privileges – Oral & Maxillofacial Surgery.” It standardizes the privileging process for Army dental officers and other qualified providers in the specialty of OMS (often associated with AOC 63N).

Purpose: It defines the scope of surgical and non-surgical care a provider can deliver, covering diagnosis, treatment, and management of conditions affecting the hard and soft tissues of the oral and maxillofacial regions. This includes functional, aesthetic, traumatic, and reconstructive aspects.

The form is part of a broader series of DA Form 5440 variants used across medical and dental specialties. Providers must also reference related forms, such as DA Form 5440-13 (General Surgery) where applicable.

Who Uses This Form?

  • Providers: Army Oral and Maxillofacial Surgeons, typically DDS/DMD graduates who have completed accredited OMS residency programs.
  • Supervisors: Department/Service Chiefs or designated clinical supervisors.
  • Credentials Committee/Function: Reviews recommendations before commander approval.
  • Facilities: U.S. Army Medical Treatment Facilities (MTFs) worldwide.

It supports credentialing for active duty, reserve, and other qualified personnel to ensure high standards of care for service members, families, and beneficiaries.

Key Sections and How the Form Works

Provider Instructions (Section I):

  • Enter codes (1-5) in the “REQUESTED” column for each privilege.
  • Codes: 1 = Fully competent; 2 = Modification requested; 3 = Supervision requested; 4/5 = Not requested (expertise or facility reasons).
  • Sign and date.

Supervisor Review:

  • Codes in “APPROVED” column.
  • Overall recommendation in Section II.

Credentials Committee:

  • Final recommendation (Approval, with modifications, or Disapproval) in Section III.

Core Privilege Areas (Summary from the form):

  • Anesthesia: Nitrous oxide, IV moderate/deep sedation, general anesthesia (ASA 1-2).
  • Dentoalveolar Surgery: Exodontia, alveoloplasty, exostosis removal, vestibuloplasty.
  • Implants: Intraoral/endosteal, extraoral, cosmetic (chin, zygoma, etc.).
  • Pathology: Biopsies, tumor removal, sinusotomy, salivary gland surgery, management of osteoradionecrosis.
  • Reconstruction: Maxillary/mandibular/facial reconstruction.
  • Temporomandibular Joint (TMJ): Arthrotomy, arthroscopy, arthrocentesis, total joint reconstruction.
  • Trauma Management: Laceration repair, closed/open reduction of facial fractures (mandible, maxilla/Le Fort, nasal, orbital, zygomatic, NOE complex), tracheostomy/cricothyroidotomy.
  • Orthognathic Jaw Surgery: Le Fort I/II/III osteotomies, mandibular osteotomies, malar osteotomy.
  • Infections: Intra/extra-oral incision and drainage.
  • Reconstructive/Bone Graft Surgery: Harvest from iliac, rib, calvarial, tibial; cartilage, skin grafts, nerve harvest; flaps (pedicle/microvascular).
  • Cleft Lip/Palate and Nerve Repairs.
  • Facial Cosmetic Procedures: Augmentation, blepharoplasty, brow lift, liposuction, resurfacing, septorhinoplasty, rhytidectomy, scar revision, otoplasty, Botox.
  • Laser Privileges: Specific training and policy acknowledgment required.
  • Miscellaneous: History & physical, hospital admission.

Note: Practitioners may admit patients and provide ICU care per MTF policy. Many privileges overlap with or require general dentistry privileges.

Why This Form Matters for Patient Safety and Compliance?

Privileging under AR 40-68 protects patients by matching provider capabilities to facility resources and mission needs. It supports ongoing competency assessment, proctoring, and renewal processes. Changes to privileges require a new form submission.

In military contexts, OMS providers handle complex trauma, deployable care, and full-scope surgery, making accurate delineation essential.

How to Download DA Form 5440-48?

Official PDF Download:
DA Form 5440-48 PDF (U.S. Army Publishing Directorate).

Fillable versions are available on authorized Army sites or tools like Army Publishing Directorate portals. Always use the latest official source for compliance.

Related Resources and Best Practices (USA-Focused)

  • AR 40-68 (Clinical Quality Management): Governs the entire process.
  • DOD and Service-Specific MPLs: Air Force and other branches publish similar Master Privilege Lists for OMS.
  • Civilian Equivalents: Many civilian hospitals use similar delineation-of-privileges forms for OMS, often requiring American Board of Oral and Maxillofacial Surgery (ABOMS) certification or eligibility.
  • Army OMS Careers: Opportunities include residencies at facilities like Womack Army Medical Center, Tripler, or Madigan.

For providers transitioning to civilian practice, this form documents extensive experience valuable for hospital credentialing applications.