DA Form 5440-21 Delineation of Clinical Privileges - Physical Therapy

What Is DA Form 5440-21?

This is a military form that was released by the U.S. Department of the Army (DA) on February 1, 2004. The form, often mistakenly referred to as the DD Form 5440-21, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

• A 2-page document available for download in PDF;
• The latest version available from the Army Publishing Directorate;
• Additional instructions and information can be found on page 1 of the document;
• Editable, free, and easy to use;
• Fill out the form in our online filing application.

Download an up-to-date printable DA Form 5440-21 down below in PDF format or browse hundreds of other DA Forms stored in our online database.