DAFORMFILLABLE.COM | DA FORM 5440-50 Fillable – Army Pubs 5440-50 PDF – DA FORM 5440-50, titled Delineation Of Clinical Privileges – Vascular Surgery, is a critical document for healthcare professionals specializing in vascular surgery within the Department of the Army. This form outlines the specific clinical privileges granted to a vascular surgeon, ensuring that only qualified professionals perform specialized procedures.
DA FORM 5440-50 – Delineation Of Clinical Privileges – Vascular Surgery
| Form Number | DA Form 5440-50 |
| Form Title | Delineation Of Clinical Privileges – Vascular Surgery |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5440-50
Publication Number: DA FORM 5440-50
Publication Date: 02/01/2004
Title: Delineation Of Clinical Privileges – Vascular Surgery
Proponent: TSG (The Surgeon General)
Status: Active
Prescribing Directive: AR 40-68
Security Classification: Unclassified
Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
Item Only Produced in Electronic Media
Requires Privacy Act Statement: (AR 340-21)
Importance of Clinical Privileges in Vascular Surgery
The DA FORM 5440-50 plays a pivotal role in maintaining high standards of care in military healthcare facilities. It ensures that vascular surgeons are appropriately credentialed and authorized to perform specific procedures. This process safeguards patient safety and upholds the integrity of medical services.
Key Components of DA FORM 5440-50
- Clinical Privileges: The form lists detailed privileges that a vascular surgeon can be granted, ranging from diagnostic procedures to complex surgical interventions.
- Credentialing: It requires thorough documentation of the surgeon’s qualifications, including education, training, and professional experience.
- Approval Process: The form must be reviewed and approved by the appropriate medical authority, ensuring that all granted privileges align with the surgeon’s capabilities and institutional requirements.
Filling Out DA FORM 5440-50
Completing the DA FORM 5440-50 involves several steps to ensure accuracy and compliance with AR 40-68 regulations.
Steps to Complete DA FORM 5440-50
- Personal Information: Enter the surgeon’s full name, rank, and contact information.
- Education and Training: Document all relevant educational qualifications and specialized training in vascular surgery.
- Professional Experience: Detail the surgeon’s work history, emphasizing experience in vascular surgical procedures.
- Clinical Privileges Requested: List the specific procedures for which the surgeon is seeking privileges. This may include both diagnostic and therapeutic interventions.
- Review and Approval: The form must be signed and dated by the appropriate credentialing authority, affirming that the surgeon meets all necessary qualifications.
Ensuring Compliance and Privacy
Adhering to the Privacy Act Statement (AR 340-21) is crucial when completing and handling the DA FORM 5440-50. This ensures that all personal information is protected and used in accordance with federal regulations.
Privacy and Security Measures
- Confidentiality: All personal and professional information on the form must be kept confidential and only shared with authorized personnel.
- Electronic Media: Since the form is produced electronically, secure systems must be used to store and transmit the document.
Conclusion
The DA FORM 5440-50 – Delineation Of Clinical Privileges – Vascular Surgery is a vital tool in the credentialing process for vascular surgeons in the military. It ensures that only qualified surgeons are granted privileges to perform specialized procedures, thereby maintaining high standards of care and patient safety. By following the prescribed guidelines and ensuring compliance with privacy regulations, healthcare facilities can effectively manage clinical privileges and uphold the integrity of their services.
DA FORM 5440-50 Fillable – Army Pubs 5440-50 PDF DOWNLOAD
