DAFORMFILLABLE.COM | DA FORM 5441-36 Fillable – Army Pubs 5441-36 PDF – DA FORM 5441-36 – Evaluation of Clinical Privileges – Audiology is an essential document used within the U.S. Army to assess and verify the clinical privileges of audiologists. This form ensures that audiology professionals meet the necessary standards and qualifications to provide high-quality care to military personnel.
DA FORM 5441-36 – Evaluation Of Clinical Privileges – Audiology
| Form Number | DA Form 5441-36 |
| Form Title | Evaluation Of Clinical Privileges – Audiology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance
The primary purpose of DA FORM 5441-36 is to evaluate the clinical competencies of audiologists. This evaluation is crucial for maintaining the integrity and quality of audiological services within the military healthcare system. By adhering to the guidelines set forth in AR 40-68, this form helps ensure that only qualified professionals are granted clinical privileges.
Key Features of DA FORM 5441-36
- Publication Number: DA FORM 5441-36
- Publication Date: 02/01/2004
- Proponent: TSG (The Surgeon General)
- Status: Active
- Prescribing Directive: AR 40-68
- Footnotes:
- Item only produced in electronic media.
- Requires Privacy Act Statement (AR 340-21).
- Security Classification: Unclassified
- Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
- Form IDN: 990001
- Form PIN: 081277
Structure and Content of DA FORM 5441-36
Section 1: Personal and Professional Information
This section collects basic information about the audiologist, including their name, rank, and professional qualifications. It serves as an identification and background check to ensure that the individual meets the initial criteria for evaluation.
Section 2: Clinical Privileges Requested
Audiologists must specify the clinical privileges they seek. This section is critical as it outlines the scope of practice the audiologist intends to perform. The requested privileges must align with their training and expertise.
Section 3: Evaluation of Competence
The core of DA FORM 5441-36 is the evaluation of the audiologist’s competence. This section involves a detailed assessment of the individual’s skills and knowledge in various audiological procedures. Evaluators use standardized criteria to ensure a fair and consistent evaluation process.
Section 4: Recommendations and Approval
After the evaluation, recommendations are made regarding the granting of clinical privileges. This section includes the signatures of the evaluating authorities, indicating their approval or disapproval of the requested privileges.
Importance of Compliance
Adherence to AR 40-68
Compliance with AR 40-68 is mandatory for the proper utilization of DA FORM 5441-36. This regulation outlines the standards for medical services and the procedures for evaluating clinical privileges. By following these guidelines, the Army ensures that all healthcare providers meet the required standards.
Privacy and Security
The form requires a Privacy Act Statement as per AR 340-21, ensuring that all personal information is handled with the utmost confidentiality. The unclassified status and unrestricted distribution code allow for broad accessibility while maintaining security and privacy standards.
Conclusion
DA FORM 5441-36 – Evaluation of Clinical Privileges – Audiology plays a vital role in maintaining the quality of audiological services within the U.S. Army. By providing a standardized method for evaluating clinical competencies, this form ensures that only qualified audiologists are granted the necessary privileges to perform their duties. Understanding and adhering to the guidelines set forth by AR 40-68 and ensuring compliance with privacy regulations are essential for the effective use of this form.
For further information or to access DA FORM 5441-36, individuals can refer to the electronic media provided or contact the relevant military medical authorities.
DA FORM 5441-36 Fillable – Army Pubs 5441-36 PDF DOWNLOAD
