DAFORMFILLABLE.COM | DA FORM 5440A Fillable – Army Pubs 5440A PDF – DA FORM 5440A, titled “Approval Of Clinical Privileges/Staff Appointment”, is an essential document used within the United States Army to formalize the granting of clinical privileges and staff appointments to healthcare professionals. Effective and precise documentation is crucial for maintaining high standards of medical care and ensuring compliance with regulatory requirements. This article provides a detailed overview of DA FORM 5440A, including its purpose, usage, and key considerations.
DA FORM 5440A – Approval Of Clinical Privileges/Staff Appointment
| Form Number | DA Form 5440A |
| Form Title | Approval Of Clinical Privileges/Staff Appointment |
| Form Date | 04/01/2009 |
| Form Proponent | TSG |
Overview of DA FORM 5440A
Pub/Form Number: DA FORM 5440A
Pub/Form Date: 04/01/2009
Pub/Form Title: Approval Of Clinical Privileges/Staff Appointment
Pub/Form Proponent: TSG (The Surgeon General)
Pub/Form Status: Active
Prescribed Forms/Prescribing Directive: AR 40-68
Footnotes:
- 14: Requires Privacy Act Statement (AR 340-21)
- 42: Item only produced in electronic media
Security Classification: Unclassified
Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
Pub/Form IDN: 990001
Pub/Form PIN: 066579
Purpose and Importance
Granting Clinical Privileges
The primary purpose of DA FORM 5440A is to grant clinical privileges to qualified healthcare professionals. Clinical privileges are the authorizations given to a healthcare provider to perform specific procedures and provide patient care within a defined scope of practice. This process ensures that only competent and qualified individuals are allowed to deliver healthcare services, thereby maintaining high standards of patient care.
Staff Appointment
In addition to clinical privileges, DA FORM 5440A is also used for staff appointments. Staff appointments involve assigning healthcare professionals to specific positions within a medical facility. This formal recognition is crucial for the orderly operation of healthcare services and for delineating the roles and responsibilities of each staff member.
Key Components of DA FORM 5440A
Personal and Professional Information
DA FORM 5440A collects detailed personal and professional information about the healthcare provider. This includes:
- Name
- Rank
- Social Security Number
- Medical Specialty
- Licensure and Certification Information
Privilege and Appointment Details
The form outlines the specific clinical privileges being granted, such as:
- Surgical procedures
- Diagnostic tests
- Treatment protocols
It also includes details about the staff appointment, specifying the department and position within the medical facility.
Approval and Signatures
The form requires signatures from various authorities to validate the granting of privileges and appointments. These typically include:
- Department Chief
- Hospital Commander
- Medical Credentialing Board
Compliance and Privacy Considerations
AR 40-68 Directive
DA FORM 5440A is prescribed by AR 40-68, which outlines the policies and procedures for granting clinical privileges and appointments. Adhering to this directive is essential for ensuring compliance with Army regulations and maintaining the integrity of the credentialing process.
Privacy Act Statement
According to AR 340-21, DA FORM 5440A requires a Privacy Act Statement. This statement informs the individual about the purpose of collecting personal information, how it will be used, and the measures in place to protect their privacy. Ensuring compliance with the Privacy Act is crucial for safeguarding sensitive information and maintaining trust in the credentialing process.
Usage and Distribution
Electronic Media
DA FORM 5440A is only produced in electronic media (footnote 42). This ensures that the form is easily accessible and can be efficiently processed and stored within electronic health record systems.
Public Release and Distribution
The form is approved for public release with unlimited distribution (Distribution Restriction Code: A). This means that there are no restrictions on who can access or use the form, facilitating widespread availability and use across the Army’s healthcare facilities.
Conclusion
DA FORM 5440A – Approval Of Clinical Privileges/Staff Appointment is a vital document in the Army’s healthcare system. By ensuring that healthcare providers are properly credentialed and appointed, it plays a crucial role in maintaining high standards of medical care. Understanding the purpose, components, and compliance requirements of this form is essential for healthcare administrators and professionals within the military system.
For more detailed information on DA FORM 5440A, refer to AR 40-68 and ensure compliance with all prescribed directives and privacy considerations.
DA FORM 5440A Fillable – Army Pubs 5440A PDF DOWNLOAD
