DAFORMFILLABLE.COM | DA FORM 5440-58 Fillable – Army Pubs 5440-58 PDF – DA FORM 5440-58, officially titled Delineation of Clinical Privileges – Substance Abuse Rehabilitation, is a critical document used in the military healthcare system. This form plays a vital role in ensuring that healthcare providers working in substance abuse rehabilitation are granted the appropriate clinical privileges necessary to perform their duties effectively and safely.
DA FORM 5440-58 – Delineation Of Clinical Privileges – Substance Abuse Rehabilitation
| Form Number | DA Form 5440-58 |
| Form Title | Delineation Of Clinical Privileges – Substance Abuse Rehabilitation |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance of DA FORM 5440-58
The DA FORM 5440-58 serves to delineate clinical privileges for healthcare professionals involved in substance abuse rehabilitation. This form ensures that only qualified personnel are authorized to provide specific types of care and treatment, thereby maintaining high standards of healthcare and patient safety.
Key Functions
- Defines Clinical Scope: The form specifies the types of procedures and treatments that a healthcare provider is authorized to perform.
- Ensures Competency: By outlining the qualifications required for each privilege, the form helps maintain a competent and qualified workforce.
- Regulatory Compliance: The form is mandated by AR 40-68, ensuring that clinical privileges are granted in compliance with military regulations.
Components of DA FORM 5440-58
Section 1: Provider Information
This section captures essential details about the healthcare provider, including:
- Name
- Rank
- Specialty
- Military Treatment Facility (MTF) Assignment
Section 2: Clinical Privileges
In this section, specific clinical privileges are listed, detailing the types of procedures and treatments the provider is authorized to perform. Each privilege is defined with corresponding qualifications and criteria.
Section 3: Approvals
This section includes signatures and dates from both the provider and the approving authorities, indicating that the privileges have been reviewed and approved according to military healthcare standards.
Implementation and Compliance
AR 40-68: The Prescribing Directive
DA FORM 5440-58 is prescribed by AR 40-68, which outlines the policies and procedures for granting clinical privileges within the military healthcare system. Compliance with this regulation ensures that healthcare providers meet the necessary standards for competency and qualification.
Privacy and Distribution
As per the form’s footnotes, it requires a Privacy Act Statement (AR 340-21), ensuring that the personal information collected is handled with confidentiality. Additionally, the form is produced exclusively in electronic media, enhancing accessibility and ease of use.
Security and Public Release
The form is classified as UNCLASSIFIED and is approved for public release, meaning it can be distributed without restriction. This broadens access to the form, making it easier for authorized personnel to obtain and use it.
Importance for Substance Abuse Rehabilitation
Enhancing Treatment Quality
By clearly delineating clinical privileges, DA FORM 5440-58 ensures that only qualified healthcare providers are involved in substance abuse rehabilitation. This enhances the quality of care provided to service members struggling with substance abuse issues.
Ensuring Patient Safety
The form plays a crucial role in safeguarding patient safety. By restricting certain clinical activities to qualified personnel, it minimizes the risk of errors and improves overall treatment outcomes.
Conclusion
DA FORM 5440-58 is an essential document within the military healthcare system, particularly for substance abuse rehabilitation. It ensures that healthcare providers are appropriately qualified and authorized to perform specific clinical activities, thereby upholding high standards of care and patient safety. Understanding and utilizing this form is crucial for maintaining the efficacy and integrity of substance abuse rehabilitation programs in the military.
By adhering to the guidelines and requirements outlined in DA FORM 5440-58, the military healthcare system can continue to provide effective and safe treatment for those in need of substance abuse rehabilitation services.
DA FORM 5440-58 Fillable – Army Pubs 5440-58 PDF DOWNLOAD
