DAFORMFILLABLE.COM | DA FORM 5441-34 Fillable – Army Pubs 5441-34 PDF – The DA FORM 5441-34, titled Evaluation Of Clinical Privileges – Behavioral Health Practitioner, is a crucial document used within the military healthcare system. This form, with a publication date of February 1, 2004, is actively used to evaluate the clinical privileges of behavioral health practitioners. Managed by the TSG (The Surgeon General), it plays a vital role in maintaining high standards of care in military medical facilities.
DA FORM 5441-34 – Evaluation Of Clinical Privileges – Behavioral Health Practitioner
| Form Number | DA Form 5441-34 |
| Form Title | Evaluation Of Clinical Privileges – Behavioral Health Practitioner |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance
Ensuring Quality of Care
The primary purpose of the DA FORM 5441-34 is to ensure that behavioral health practitioners meet the necessary qualifications and competencies required to provide care. By conducting thorough evaluations, the form helps in maintaining the quality and safety of behavioral health services provided to military personnel.
Compliance with Regulations
This form is prescribed by AR 40-68, which outlines the requirements for clinical privileges within the Army Medical Department. Compliance with this regulation is essential for the standardization of evaluations across different facilities and ensures that all practitioners are held to the same high standards.
Key Features of DA FORM 5441-34
Privacy and Security
The DA FORM 5441-34 includes a Privacy Act Statement as required by AR 340-21. This ensures that the personal information of the practitioners being evaluated is protected. Additionally, the form is UNCLASSIFIED and approved for public release, meaning its distribution is unlimited, enhancing transparency in the evaluation process.
Electronic Media
This form is produced solely in electronic media (Footnote 42), facilitating easy access and submission. This also helps in maintaining accurate records and streamlining the evaluation process.
Detailed Evaluation Criteria
The form includes comprehensive sections for evaluating various competencies and skills specific to behavioral health practitioners. These evaluations help in determining whether a practitioner can be granted, denied, or have their clinical privileges modified.
Completing DA FORM 5441-34
Sections and Fields
The form consists of several sections that cover different aspects of a practitioner’s qualifications:
Personal Information
This section captures the basic details of the practitioner, including their name, rank, and contact information.
Professional Qualifications
Evaluators provide information about the practitioner’s education, training, certifications, and experience relevant to their behavioral health practice.
Competency Evaluation
This is a critical section where specific skills and competencies are assessed. Evaluators rate the practitioner’s ability to perform various clinical tasks and procedures.
Submission and Review
Once completed, the form must be reviewed and signed by the appropriate supervisory and administrative personnel. This ensures that the evaluation is thorough and meets all regulatory requirements.
Benefits of Using DA FORM 5441-34
Standardization
The use of DA FORM 5441-34 helps standardize the evaluation process across different military medical facilities. This ensures that all practitioners are evaluated using the same criteria, which contributes to maintaining consistent quality of care.
Accountability
By documenting the evaluation process, the form promotes accountability among both the evaluators and the practitioners. It provides a clear record of the qualifications and competencies of each practitioner, which is crucial for both professional development and regulatory compliance.
Enhanced Patient Safety
Thorough evaluations help in identifying any areas where a practitioner may need additional training or support. This proactive approach enhances patient safety by ensuring that only qualified practitioners are granted clinical privileges.
Conclusion
The DA FORM 5441-34 – Evaluation Of Clinical Privileges – Behavioral Health Practitioner is an essential tool in the military healthcare system. It ensures that behavioral health practitioners are thoroughly evaluated and meet the necessary qualifications to provide high-quality care. By adhering to the standards and procedures outlined in AR 40-68, this form helps maintain the integrity and safety of behavioral health services in the military.
Understanding and utilizing DA FORM 5441-34 effectively is crucial for both practitioners and evaluators. It promotes a culture of excellence and accountability, ultimately benefiting the health and well-being of military personnel.
DA FORM 5441-34 Fillable – Army Pubs 5441-34 PDF DOWNLOAD
