DAFORMFILLABLE.COM | DA FORM 5440-19 Fillable – Army Pubs 5440-19 PDF – DA FORM 5440-19, titled Delineation Of Clinical Privileges-Dietetics, is a crucial document used within the Army medical system. The form, published on February 1, 2004, by the Office of The Surgeon General (TSG), outlines the specific clinical privileges granted to dietitians working in military medical facilities. This form is essential for ensuring that dietitians are appropriately credentialed and authorized to perform specific clinical functions.
DA FORM 5440-19 – Delineation Of Clinical Privileges-Dietetics
| Form Number | DA Form 5440-19 |
| Form Title | Delineation Of Clinical Privileges-Dietetics |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance
The DA FORM 5440-19 serves multiple purposes:
- Delineation of Clinical Privileges: It explicitly states the clinical activities that a dietitian is permitted to perform. This ensures that dietitians operate within their scope of practice, promoting patient safety and high standards of care.
- Credentialing and Privileging: It is a part of the credentialing process mandated by AR 40-68, which governs the credentialing and privileging of healthcare professionals within the Army. This regulation ensures that only qualified individuals provide clinical care.
- Compliance and Record-Keeping: The form is produced in electronic media, as indicated by footnote 42, facilitating easier record-keeping and compliance with privacy requirements stated in AR 340-21.
Structure and Content
The DA FORM 5440-19 includes several key sections that outline the privileges and responsibilities of dietitians:
- Personal Information: Includes the dietitian’s name, rank, and identification details.
- Clinical Privileges: Lists the specific clinical tasks and procedures that the dietitian is authorized to perform. This section is critical as it delineates the boundaries of practice.
- Approval and Authorization: Contains signatures from relevant authorities, confirming the granting of privileges.
Privacy and Security
This form requires a Privacy Act Statement to ensure compliance with privacy laws. The information provided on the form is protected under AR 340-21, which governs the handling of personal data within the Army.
Accessibility and Distribution
The DA FORM 5440-19 is classified as UNCLASSIFIED and has a distribution restriction code of A, meaning it is approved for public release and distribution is unlimited. This ensures that all relevant personnel can access and utilize the form as needed.
Conclusion
In summary, the DA FORM 5440-19 – Delineation Of Clinical Privileges-Dietetics is a vital document in the Army medical system, ensuring that dietitians are properly credentialed and authorized to perform specific clinical tasks. By clearly outlining the scope of practice, it helps maintain high standards of care and patient safety. Compliance with regulations such as AR 40-68 and AR 340-21 underscores its importance in the credentialing and privileging process.
By understanding and utilizing this form, military medical facilities can ensure that dietitians provide high-quality, safe, and effective care to their patients.
DA FORM 5440-19 Fillable – Army Pubs 5440-19 PDF DOWNLOAD
