DAFORMFILLABLE.COM | DA FORM 5440-16 Fillable – Army Pubs 5440-16 PDF – DA FORM 5440-16, titled Delineation Of Clinical Privileges-Nurse Practitioner, is an essential document used within the healthcare system to specify and authorize the clinical privileges of nurse practitioners. This form is significant in ensuring that nurse practitioners perform only those tasks for which they are qualified and authorized. This article aims to provide a comprehensive understanding of DA FORM 5440-16, its purpose, and its utilization.
DA FORM 5440-16 – Delineation Of Clinical Privileges-Nurse Practitioner
| Form Number | DA Form 5440-16 |
| Form Title | Delineation Of Clinical Privileges-Nurse Practitioner |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Understanding DA FORM 5440-16
Publication Details
- Pub/Form Number: DA FORM 5440-16
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Delineation Of Clinical Privileges-Nurse Practitioner
- Pub/Form Proponent: TSG
- Pub/Form Status: ACTIVE
Key Information
- Security Classification: UNCLASSIFIED
- Distribution Restriction Code: A – Approved for public release; distribution is unlimited
- Pub/Form IDN: 990001
- Pub/Form PIN: 066518
Purpose of DA FORM 5440-16
DA FORM 5440-16 is used to delineate and document the specific clinical privileges granted to nurse practitioners within a medical facility. These privileges outline the procedures and treatments that a nurse practitioner is authorized to perform. The form ensures that nurse practitioners operate within the scope of their training, education, and experience, thereby promoting patient safety and quality care.
Importance of Clinical Privileges
Clinical privileges are critical for maintaining high standards in healthcare. They ensure that only qualified healthcare professionals perform certain medical procedures. By clearly defining what a nurse practitioner can and cannot do, DA FORM 5440-16 helps prevent medical errors and enhances the overall quality of care.
Regulatory Framework
Prescribing Directive
The use and management of DA FORM 5440-16 are governed by AR 40-68, which provides guidelines for the credentialing and privileging of healthcare providers within the Army Medical Department.
Privacy Act Statement
DA FORM 5440-16 requires a Privacy Act Statement in accordance with AR 340-21. This statement ensures that individuals’ personal information is protected and handled according to federal privacy regulations.
Components of DA FORM 5440-16
Sections and Fields
The form is divided into various sections that capture essential information about the nurse practitioner and the clinical privileges being granted. Key sections include:
- Personal Information: Details about the nurse practitioner, including name, rank, and identification number.
- Qualifications: Information on the nurse practitioner’s education, training, and certifications.
- Clinical Privileges: A detailed list of specific procedures and treatments the nurse practitioner is authorized to perform.
- Approvals and Signatures: Signatures from relevant authorities confirming the granting of clinical privileges.
Electronic Media
This form is only produced in electronic media, which facilitates ease of access, completion, and storage. The digital format ensures that the form is readily available and can be easily integrated into electronic health records systems.
Usage and Implementation
How to Complete the Form
Nurse practitioners and credentialing officers must complete the form accurately, ensuring that all sections are filled out correctly. The form should be reviewed periodically to update privileges as necessary, reflecting any changes in the nurse practitioner’s qualifications or scope of practice.
Submission and Approval
Once completed, the form must be submitted to the appropriate medical credentialing authority for review and approval. The approval process includes verification of the nurse practitioner’s credentials and an assessment of their competence to perform the listed clinical privileges.
Conclusion
DA FORM 5440-16 – Delineation Of Clinical Privileges-Nurse Practitioner is a vital tool in the healthcare system, ensuring that nurse practitioners provide care within their scope of practice. By delineating clinical privileges, this form helps maintain high standards of patient care and safety. Understanding its purpose, regulatory framework, and components is crucial for healthcare professionals involved in the credentialing process. For more information or to access the form, visit the official Army publishing site or contact the relevant medical credentialing office.
DA FORM 5440-16 Fillable – Army Pubs 5440-16 PDF DOWNLOAD
