DA FORM 5440-14 Fillable – Army Pubs 5440-14 PDF

DAFORMFILLABLE.COM | DA FORM 5440-14 Fillable – Army Pubs 5440-14 PDFDA FORM 5440-14, titled “Delineation Of Clinical Privileges-Nurse Anesthetists,” is a critical document used in the military healthcare system. Established on February 1, 2004, this form outlines the specific clinical privileges granted to nurse anesthetists. The form is prescribed by AR 40-68 and is essential for maintaining standards and ensuring the competency of healthcare providers within the military.

DA FORM 5440-14 – Delineation Of Clinical Privileges-Nurse Anesthetists

Form Number DA Form 5440-14
Form Title Delineation Of Clinical Privileges-Nurse Anesthetists
Form Date 02/01/2004
Form Proponent TSG

Purpose and Importance of DA FORM 5440-14

Ensuring Competency and Quality of Care

The DA FORM 5440-14 is designed to clearly define the clinical privileges of nurse anesthetists within the military healthcare system. This form plays a vital role in ensuring that these professionals are qualified to perform specific procedures and tasks. By delineating these privileges, the form helps maintain high standards of patient care and safety.

Compliance with Regulations

This form is governed by AR 40-68, which provides comprehensive guidelines for the delineation of clinical privileges in the Army Medical Department. Adherence to these regulations is crucial for legal and operational compliance, ensuring that nurse anesthetists perform only those procedures for which they are formally credentialed.

Structure and Content of DA FORM 5440-14

Key Sections

The DA FORM 5440-14 comprises several sections, each serving a specific purpose in the credentialing process:

  1. Personal Information: This section collects essential details about the nurse anesthetist, including name, rank, and contact information.
  2. Clinical Privileges: Here, the specific clinical tasks and procedures the nurse anesthetist is authorized to perform are listed. This section is crucial for delineating the scope of practice.
  3. Approval and Signatures: This section includes the signatures of the credentialing authority and the nurse anesthetist, indicating agreement and approval of the listed privileges.

Privacy and Security

The form includes a Privacy Act Statement as required by AR 340-21, ensuring that personal information is handled in compliance with privacy regulations. The document is classified as UNCLASSIFIED and is available for public release, with distribution being unlimited.

Usage and Distribution

Electronic Media

The DA FORM 5440-14 is produced exclusively in electronic media, facilitating easy access and distribution. This digital format supports efficient management and updating of clinical privileges.

Public Release

Classified as “A APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED,” this form can be freely distributed and accessed, making it an essential resource for military healthcare providers and administrative personnel.

Conclusion

The DA FORM 5440-14 – Delineation Of Clinical Privileges-Nurse Anesthetists is a fundamental document in the military healthcare system, ensuring that nurse anesthetists are appropriately credentialed and qualified to deliver high-quality care. By adhering to the guidelines set forth in AR 40-68 and incorporating comprehensive sections on personal information, clinical privileges, and approvals, this form plays a critical role in maintaining standards and compliance. As an electronic document with unlimited distribution, it supports the efficient management and dissemination of clinical privileges within the military.

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