Get Da 5440-38 2004-2025
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How to fill out the DA 5440-38 online
The DA 5440-38 is an important form used for delineation of clinical privileges in clinical pharmacy. This guide provides clear, step-by-step instructions to assist users in completing this form online effectively.
Follow the steps to fill out the DA 5440-38 online.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Begin by entering your name in the space provided for 'Name of Provider' (Last, First, MI). This ensures your identification is clear and accurate.
- Input your rank or grade in the designated field. This might affect your eligibility for certain privileges listed on the form.
- In the 'Facility' section, enter the name of the facility where you practice. This helps to connect your privileges to the specific location.
- In Section I, you will need to indicate the privileges you are requesting. Use the column labeled 'Requested' to enter the appropriate provider codes for each privilege.
- For any criteria or applications that do not apply to you, line through and initial those items, ensuring that your document reflects only the relevant requests.
- As the provider, your signature is required at the end of Section I, certifying the accuracy of the information provided.
- In Section II, your supervisor will review and provide their approval in the 'Approved' column. They should enter the appropriate approval code for each privilege.
- Once your supervisor has completed their entry, they must also sign and date the document in the designated space.
- After completing all necessary sections, you will have the option to save changes, download the completed form, print it, or share electronically as required.
Complete your DA 5440-38 form online today for seamless processing.
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