DAFORMFILLABLE.COM | DA FORM 5440-22 Fillable – Army Pubs 5440-22 PDF – DA FORM 5440-22 – Delineation Of Clinical Privileges is a critical document used within the United States Army to specify and authorize the clinical privileges of healthcare professionals. This form ensures that medical personnel operate within the scope of their qualifications, training, and experience, thus maintaining high standards of patient care and safety. This article will provide a comprehensive overview of the form, its purpose, and its significance in the military healthcare system.
DA FORM 5440-22 – Delineation Of Clinical Privileges
| Form Number | DA Form 5440-22 |
| Form Title | Delineation Of Clinical Privileges |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
What is DA FORM 5440-22?
DA FORM 5440-22 is an official form titled “Delineation Of Clinical Privileges”. It was first published on February 1, 2004, and remains an active document within the military healthcare framework. The form is prescribed by AR 40-68 and requires compliance with the Privacy Act Statement as per AR 340-21.
Key Details of DA FORM 5440-22
- Pub/Form Number: DA FORM 5440-22
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Delineation Of Clinical Privileges
- Pub/Form Proponent: TSG (The Surgeon General)
- Pub/Form Status: Active
- Prescribed Forms/Prescribing Directive: AR 40-68
- Security Classification: Unclassified
- Dist Restriction Code: A (Approved for public release; distribution is unlimited)
- Pub/Form IDN: 990001
- Pub/Form PIN: 066566
Purpose of DA FORM 5440-22
The primary purpose of DA FORM 5440-22 is to outline and authorize the clinical privileges of healthcare professionals within the Army. This form ensures that medical personnel are granted the authority to perform specific clinical tasks based on their credentials, training, and demonstrated competencies. It helps in maintaining the quality and safety of healthcare services provided to soldiers and their families.
Importance of Clinical Privileges
Clinical privileges refer to the specific procedures and activities that healthcare professionals are authorized to perform within their field of expertise. By delineating these privileges, the Army ensures that:
- Healthcare providers operate within their scope of practice.
- Patient safety is maintained by preventing unauthorized or unqualified personnel from performing certain procedures.
- Standards of care are upheld by ensuring that only qualified and competent professionals provide medical services.
Completing DA FORM 5440-22
To complete DA FORM 5440-22, healthcare professionals must provide detailed information about their qualifications, training, and experience. The form typically includes sections for:
- Personal Information: Name, rank, and contact details of the healthcare provider.
- Qualifications: Details of medical education, certifications, and licenses.
- Clinical Privileges: A list of specific clinical activities and procedures that the provider is authorized to perform.
- Approval: Signatures from the healthcare provider, supervising officer, and relevant authorities to validate the granted privileges.
Privacy and Security Considerations
As DA FORM 5440-22 requires the inclusion of personal and professional information, it is subject to the Privacy Act Statement under AR 340-21. This ensures that the information is handled with confidentiality and used only for its intended purpose.
Access and Distribution
DA FORM 5440-22 is an unclassified document with a distribution restriction code A, meaning it is approved for public release and its distribution is unlimited. The form is available in electronic media only, as indicated by its footnote: “42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA.”
Conclusion
DA FORM 5440-22 – Delineation Of Clinical Privileges is an essential tool in the military healthcare system. It ensures that healthcare professionals are authorized to perform specific clinical tasks based on their qualifications and competencies, thereby maintaining high standards of patient care and safety. By understanding the purpose, completion process, and significance of this form, healthcare providers and administrators can ensure its effective use in managing clinical privileges within the Army.
By following SEO best practices, this article aims to provide a clear and comprehensive overview of DA FORM 5440-22 for those seeking information on this critical document.
DA FORM 5440-22 Fillable – Army Pubs 5440-22 PDF DOWNLOAD
