DAFORMFILLABLE.COM | DA FORM 5441-58 Fillable – Army Pubs 5441-58 PDF – The DA FORM 5441-58, titled “Evaluation of Clinical Privileges – Substance Abuse Rehabilitation,” is a crucial document within the U.S. Army’s healthcare system. Published on February 1, 2004, this form is instrumental in assessing the clinical privileges of healthcare providers involved in substance abuse rehabilitation. Its proponent is TSG (The Surgeon General), and it remains an active form under the regulation AR 40-68.
DA FORM 5441-58 – Evaluation Of Clinical Privileges – Substance Abuse Rehabilitation
| Form Number | DA Form 5441-58 |
| Form Title | Evaluation Of Clinical Privileges – Substance Abuse Rehabilitation |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose of DA FORM 5441-58
The primary purpose of DA FORM 5441-58 is to evaluate the clinical competencies and privileges of professionals working in substance abuse rehabilitation within military medical facilities. This form ensures that only qualified personnel are granted the authority to provide specialized care to service members undergoing substance abuse treatment.
Key Features of DA FORM 5441-58
- Publication and Status
- Pub/Form Number: DA FORM 5441-58
- Pub/Form Date: 02/01/2004
- Pub/Form Status: Active
- Regulatory Framework
- Prescribing Directive: AR 40-68
- Footnotes:
- 14- Requires Privacy Act Statement (AR 340-21)
- 42- Item only produced in electronic media
- Distribution and Security
- Security Classification: Unclassified
- Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
Evaluative Components of DA FORM 5441-58
DA FORM 5441-58 includes several critical sections that help in the thorough evaluation of clinical privileges:
Personal Information
The form collects essential personal information of the healthcare provider, including their name, rank, and contact details. This section ensures accurate identification and tracking of the individual being evaluated.
Professional Qualifications
This section delves into the healthcare provider’s qualifications, including their education, certifications, and relevant experience in substance abuse rehabilitation. It is vital to ensure that the provider has the necessary background to deliver effective treatment.
Performance Assessment
The performance assessment part of DA FORM 5441-58 is perhaps the most significant. It evaluates the provider’s clinical skills, adherence to treatment protocols, and ability to work within a multidisciplinary team. This assessment is typically conducted by a supervising clinician who is familiar with the provider’s work.
Recommendations for Privileges
Based on the evaluation, the form includes a section where recommendations are made regarding the clinical privileges that should be granted. This could range from full privileges to restricted privileges based on specific competencies.
Importance of DA FORM 5441-58 in Substance Abuse Rehabilitation
DA FORM 5441-58 plays a pivotal role in maintaining high standards of care in substance abuse rehabilitation programs within the military. By systematically evaluating healthcare providers, the form helps ensure that only those with verified competencies are allowed to deliver care, thereby safeguarding the health and well-being of service members.
Accessibility and Use
The form is only produced in electronic media, ensuring easy access and efficient processing. It is unclassified and approved for public release, making it widely available for use within the military healthcare system.
Conclusion
In summary, DA FORM 5441-58 – Evaluation of Clinical Privileges – Substance Abuse Rehabilitation is an essential document within the Army’s healthcare framework. By providing a structured approach to evaluating the clinical privileges of healthcare providers, it helps maintain high standards of care and supports the effective rehabilitation of service members struggling with substance abuse. Adhering to the guidelines and procedures outlined in this form ensures that the best possible care is provided by qualified and competent professionals.
DA FORM 5441-58 Fillable – Army Pubs 5441-58 PDF DOWNLOAD
