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U.S. DOD Form dod-da-5440-9 DELINEATION OF CLINICAL PRIVILEGES PODIATRY For use of this form, see AR 40-68; the proponent agency is OSG. 2. RANK/GRADE 3. FACILITY 1. NAME OF PROVIDER (Last, First,
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Contractors and vendors: In some cases, contractors and vendors working with the Department of Defense may need to fill out this form to comply with certain requirements or regulations.
Remember to consult the specific instructions or guidelines provided with the form to determine if you are the intended audience and should fill out the US DOD Form DOD-DA-5440-9.
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