DAFORMFILLABLE.COM | DA FORM 5440-57 Fillable – Army Pubs 5440-57 PDF – DA FORM 5440-57, titled Delineation Of Clinical Privileges – Psychiatric Advanced Practice Nurse, is a critical document for psychiatric advanced practice nurses (APNs) within the military. This form, prescribed under AR 40-68, outlines the specific clinical privileges granted to these healthcare professionals, ensuring that they can perform their duties effectively and within their scope of practice.
DA FORM 5440-57 – Delineation Of Clinical Privileges – Psychiatric Advanced Practice Nurse
| Form Number | DA Form 5440-57 |
| Form Title | Delineation Of Clinical Privileges – Psychiatric Advanced Practice Nurse |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5440-57
Publication Number: DA FORM 5440-57
Publication Date: 02/01/2004
Form Proponent: TSG (The Surgeon General)
Form Status: Active
Prescribing Directive: AR 40-68
Security Classification: Unclassified
Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
Form Availability: Electronic Media Only
Purpose of DA FORM 5440-57
The primary purpose of DA FORM 5440-57 is to delineate the clinical privileges for psychiatric advanced practice nurses. This ensures that these nurses are authorized to perform specific tasks and responsibilities within their professional scope. The form is essential for maintaining standardized clinical practice and ensuring patient safety within military healthcare facilities.
Key Components of DA FORM 5440-57
Clinical Privileges Section
The clinical privileges section of DA FORM 5440-57 outlines the specific tasks and procedures that a psychiatric APN is permitted to perform. These privileges are based on the nurse’s education, training, and experience. It includes but is not limited to:
- Conducting psychiatric evaluations
- Managing psychopharmacological treatments
- Providing psychotherapy
- Consulting with other healthcare professionals
Approval and Review
Each privilege listed on DA FORM 5440-57 must be reviewed and approved by the appropriate medical authority. This process ensures that the psychiatric APN has demonstrated the necessary competencies to perform the tasks safely and effectively. Regular reviews are conducted to update the form as needed, reflecting any changes in the nurse’s scope of practice or institutional policies.
Importance of Compliance with AR 40-68
Compliance with AR 40-68 is crucial for the proper utilization of DA FORM 5440-57. This regulation provides comprehensive guidelines on the credentialing and privileging of healthcare professionals in the military. It ensures that all psychiatric APNs are assessed and authorized systematically, promoting high standards of care and operational efficiency.
Privacy and Security Considerations
Privacy Act Statement
According to footnote 14, DA FORM 5440-57 requires a Privacy Act Statement in compliance with AR 340-21. This statement informs individuals about the use and safeguarding of their personal information collected through the form. It is vital for maintaining confidentiality and trust in the military healthcare system.
Electronic Media Production
Footnote 42 specifies that DA FORM 5440-57 is only produced in electronic media. This modern approach enhances accessibility and efficiency in managing clinical privileges documentation. Healthcare facilities can easily access, update, and store these forms electronically, reducing the risk of errors and misplacement.
Conclusion
DA FORM 5440-57 – Delineation Of Clinical Privileges – Psychiatric Advanced Practice Nurse is an indispensable document for ensuring that psychiatric APNs in the military can perform their duties within their authorized scope. By adhering to the guidelines set forth in AR 40-68 and maintaining compliance with privacy and security requirements, this form helps uphold the highest standards of care and operational effectiveness in military healthcare settings.
For further information or to access DA FORM 5440-57, individuals can refer to the relevant military healthcare administrative resources or contact their institutional medical authority.
DA FORM 5440-57 Fillable – Army Pubs 5440-57 PDF DOWNLOAD
