DAFORMFILLABLE.COM | DA FORM 5441-4 Fillable – Army Pubs 5441-4 PDF – DA FORM 5441-4 is an essential document used in the medical field, specifically for the evaluation of clinical privileges in neurology. This form, published by the Department of the Army, is crucial for assessing the qualifications and competencies of neurology practitioners within military medical facilities. Understanding its structure and application can significantly benefit medical professionals and administrators involved in credentialing processes.
DA FORM 5441-4 – Evaluation Of Clinical Privileges-Neurology
| Form Number | DA Form 5441-4 |
| Form Title | Evaluation Of Clinical Privileges-Neurology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5441-4
Publication Details
- Pub/Form Number: DA FORM 5441-4
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Evaluation Of Clinical Privileges-Neurology
- Pub/Form Proponent: TSG (The Surgeon General)
- Pub/Form Status: ACTIVE
- Prescribed Forms/Prescribing Directive: AR 40-68
Important Notes
- Footnotes:
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- Security Classification: UNCLASSIFIED
- Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
- Pub/Form IDN: 990001
- Pub/Form PIN: 066535
Purpose and Use of DA FORM 5441-4
Purpose
The primary purpose of DA FORM 5441-4 is to evaluate the clinical privileges of neurology practitioners. It is designed to ensure that medical personnel are qualified to perform specific neurology procedures and treatments. This evaluation process is vital for maintaining high standards of care within military medical facilities.
Application
DA FORM 5441-4 is used by credentialing committees and medical boards to assess the competencies of neurology practitioners. This form helps in documenting the practitioner’s training, experience, and demonstrated abilities in various neurology procedures. The evaluation includes reviewing the practitioner’s performance in clinical settings and ensuring they meet the necessary standards for providing patient care.
Structure of DA FORM 5441-4
Sections of the Form
- Personal Information: This section captures the basic details of the practitioner being evaluated, such as name, rank, and medical specialty.
- Clinical Privileges Requested: A detailed list of neurology procedures and treatments that the practitioner is seeking privileges for. Each item needs to be evaluated based on the practitioner’s competency.
- Evaluator’s Assessment: The evaluator provides an assessment of the practitioner’s abilities in each requested area. This includes observations from direct supervision, peer reviews, and patient outcomes.
- Recommendation: Based on the assessments, the evaluator makes a recommendation regarding the granting of clinical privileges. This recommendation is crucial for the credentialing decision-making process.
Importance of DA FORM 5441-4
Ensuring Quality Care
The use of DA FORM 5441-4 is integral to maintaining high standards of patient care in neurology. By systematically evaluating the competencies of practitioners, medical facilities can ensure that only qualified individuals are granted clinical privileges. This process helps in enhancing patient safety and improving clinical outcomes.
Compliance with Regulations
Compliance with AR 40-68, the prescribing directive for DA FORM 5441-4, is mandatory. This regulation outlines the standards and procedures for the credentialing and privileging of healthcare providers within the military. Adhering to these guidelines ensures that the evaluation process is consistent and meets the required legal and professional standards.
Privacy and Security
Privacy Act Statement
The form requires a Privacy Act Statement in accordance with AR 340-21. This statement informs the practitioner about the use of their personal information and ensures that their privacy rights are protected during the evaluation process.
Distribution and Classification
DA FORM 5441-4 is unclassified and approved for public release. This ensures that the form can be widely distributed and accessed by relevant medical personnel without any security restrictions.
Conclusion
DA FORM 5441-4 – Evaluation Of Clinical Privileges-Neurology is a critical tool in the credentialing process for neurology practitioners within military medical facilities. By understanding its purpose, structure, and application, medical administrators and practitioners can ensure a rigorous evaluation process that upholds the highest standards of patient care and compliance with regulatory requirements. The proper use of this form contributes to the overall effectiveness and quality of medical services in the military health system.
DA FORM 5441-4 Fillable – Army Pubs 5441-4 PDF DOWNLOAD
