DA Form 5440-9: Podiatry Clinical Privileges Guide

DA Form 5440-9: Podiatry Clinical Privileges Guide – DA Form 5440-9 is the official U.S. Army document used to delineate clinical privileges for podiatrists serving in military medical facilities. It ensures that podiatric physicians practice only within the scope of their verified training, experience, and demonstrated competence, in accordance with AR 40-68 (Clinical Quality Management).

Download the current form here: DA Form 5440-9 PDF

What Is DA Form 5440-9 Used For?

Military podiatrists (Doctors of Podiatric Medicine – DPM) must complete this form as part of the credentialing and privileging process. It allows providers to request specific levels of care and individual procedures while enabling supervisors and credentials committees to approve or modify those privileges based on qualifications.

This form promotes patient safety, maintains high standards of care in Army medical treatment facilities (MTFs), and aligns with Joint Commission and Department of Defense credentialing requirements.

Key Sections of DA Form 5440-9

Provider and Facility Information

  • Name, rank/grade, and facility.
  • Instructions for coding privileges.

Provider Codes (Requested by the Podiatrist)

  1. Fully competent
  2. Modification requested
  3. Supervision requested
  4. Not requested (lack of expertise)
  5. Not requested (lack of facility support/mission)

Supervisor Codes (Approval)
Similar scale, with justifications required for modifications or denials.

Clinical Privilege Categories (Progressive levels):

  • Category I: Basic routine foot conditions under direct supervision of a privileged podiatrist.
  • Category II: Includes Category I + independent examination, diagnosis, and treatment of foot conditions (post-residency skills). Use consultations for complex or systemic cases.
  • Category III: Includes I & II + board certification/eligibility. Covers prevention, diagnosis, and treatment of foot complications from systemic diseases (e.g., diabetes), plus palliative and corrective procedures.

Areas of Foot Pathology

  • General Practice
  • Foot Surgery (common and complex reconstructive)
  • Podiatric Dermatology
  • Foot Orthopedics
  • Podopediatrics
  • Podogeriatrics
  • X-Ray Services (Interpretation)

Common Podiatric Surgical Procedures Listed on the Form

The form provides a detailed checklist (providers mark requested/approved):

Skin: Digital syndactylism, excision of lesions/cysts, grafts, plastic revisions, foreign body removal, toenail procedures.
Nerves: Tarsal tunnel decompression, neuroma excision.
Tendons: Lengthening, repairs, transfers, releases (e.g., plantar fascial).
Osseous: Bunionectomies (Akin, Keller, McBride), hammertoe correction, arthrodesis, ostectomies, metatarsal procedures.
Fractures/Dislocations: Open reductions.
Infections/Amputations: I&D, debridement, digital/ray/transmetatarsal amputations.
Complex Reconstructive: Rearfoot tendon work, osteotomies, triple arthrodesis, flatfoot/cavus reconstructions, ankle procedures (arthroscopy, stabilization), etc.

Section II & III: Supervisor and Credentials Committee recommendations and signatures.

Who Needs to Complete DA Form 5440-9?

  • Active Duty, Reserve, and National Guard podiatrists.
  • Civilian contractors or GS employees providing podiatric services in Army facilities.
  • Providers seeking initial appointment, renewal, or modification of privileges.

Privileges are facility-specific and must be renewed periodically per AR 40-68.

How to Fill Out and Submit DA Form 5440-9?

  1. Download the fillable PDF from Army Publishing Directorate.
  2. Complete Section I: Enter codes for each category and procedure. Line through and initial inapplicable items.
  3. Provide supporting documentation (residency certificates, board certification, case logs, proctoring records).
  4. Obtain supervisor review and signatures.
  5. Route through the credentials committee for final approval by the facility commander.
  6. Keep a copy in your provider file.

Tip: Be realistic in requests. Over-requesting without supporting evidence can delay approval.

Qualifications Typically Required for Podiatry Privileges

While the form itself references AR 40-68, common standards across military and civilian credentialing include:

  • Graduation from a CPME-accredited college of podiatric medicine.
  • Completion of a CPME-approved podiatric medicine and surgery residency (often 3 years).
  • Board certification or eligibility (ABPM or ABFAS).
  • Current licensure and malpractice history review.
  • Recent case volume documentation matching requested privileges.

Why Proper Privileging Matters in the U.S. Army?

Accurate use of DA Form 5440-9 ensures:

  • Compliance with federal regulations and Army policy.
  • Optimal patient outcomes for service members, families, and retirees.
  • Risk management and quality improvement in military healthcare.

Podiatry plays a critical role in Army medicine, especially for diabetic foot care, sports injuries, and deployment-related trauma.

  • AR 40-68: Clinical Quality Management (primary regulation).
  • Army Publishing Directorate: Official forms library.
  • DoD and Joint Commission credentialing standards.
  • For comparison: Similar delineation forms exist in Air Force, Navy, and civilian hospitals.

Need the form or help understanding a specific section? Download it directly from the official link above. For questions about your specific facility’s process, contact your Medical Treatment Facility’s Credentials Office.