DAFORMFILLABLE.COM | DA FORM 5441-53 Fillable – Army Pubs 5441-53 PDF – DA FORM 5441-53, officially titled Evaluation of Clinical Privileges – Occupational Medicine, is an essential document used within the U.S. Army medical system. Issued on February 1, 2004, this form plays a critical role in the assessment and documentation of clinical privileges for professionals in the field of occupational medicine.
DA FORM 5441-53 – Evaluation Of Clinical Privileges – Occupational Medicine
| Form Number | DA Form 5441-53 |
| Form Title | Evaluation Of Clinical Privileges – Occupational Medicine |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5441-53
What is DA FORM 5441-53?
DA FORM 5441-53 is a form used to evaluate and document the clinical privileges of medical professionals specializing in occupational medicine within the U.S. Army. This form ensures that these professionals are qualified and competent to perform specific medical tasks and procedures.
Importance of DA FORM 5441-53
The evaluation of clinical privileges is vital to maintaining high standards of medical care. DA FORM 5441-53 ensures that occupational medicine professionals are thoroughly assessed, thereby protecting patient safety and ensuring that medical personnel are capable of performing their duties effectively.
Key Features of DA FORM 5441-53
Pub/Form Information
- Pub/Form Number: DA FORM 5441-53
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Evaluation of Clinical Privileges – Occupational Medicine
- Pub/Form Proponent: TSG (The Surgeon General)
- Pub/Form Status: Active
Prescribing Directive
The form is prescribed by AR 40-68, which outlines the standards and procedures for credentialing and privileging healthcare providers in the U.S. Army. This directive ensures that only qualified individuals receive clinical privileges.
Privacy and Security
- Footnotes: The form requires a Privacy Act Statement as per AR 340-21, ensuring the protection of personal information.
- Security Classification: Unclassified
- Distribution Restriction Code: A – Approved for public release; distribution is unlimited
Structure and Usage of DA FORM 5441-53
Sections of the Form
DA FORM 5441-53 is designed to cover various aspects of a medical professional’s qualifications and performance. Key sections typically include:
- Personal Information: Details of the healthcare provider being evaluated
- Clinical Privileges Requested: Specific medical tasks and procedures the provider seeks to be authorized to perform
- Evaluation and Recommendations: Assessments by supervisors or credentialing committees, including performance reviews and competency assessments
- Final Approval: Signatures from authorized personnel granting or denying the requested privileges
Electronic Media
This form is only produced in electronic media, ensuring ease of access and submission within the military’s digital infrastructure.
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Conclusion
DA FORM 5441-53 – Evaluation of Clinical Privileges – Occupational Medicine is a crucial document within the U.S. Army medical system. It ensures that healthcare providers in the field of occupational medicine are properly evaluated and qualified to perform their duties. By maintaining stringent standards through this evaluation process, the U.S. Army upholds the quality and safety of its medical services.
DA FORM 5441-53 Fillable – Army Pubs 5441-53 PDF DOWNLOAD
