DAFORMFILLABLE.COM | DA FORM 5440-33 Fillable – Army Pubs 5440-33 PDF – DA FORM 5440-33 is a crucial document used within the United States Army Medical Department to outline the specific clinical privileges granted to urologists. This form, active since February 1, 2004, serves as an official record of the competencies and procedural permissions for urology practitioners. Below is a comprehensive guide to understanding and utilizing this important form.
DA FORM 5440-33 – Delineation Of Clinical Privileges – Urology
| Form Number | DA Form 5440-33 |
| Form Title | Delineation Of Clinical Privileges – Urology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5440-33
DA FORM 5440-33, titled Delineation Of Clinical Privileges – Urology, is designed to ensure that urologists practicing within the Army are qualified to perform specific clinical tasks. The form is prescribed by AR 40-68 and includes footnotes that require adherence to privacy act statements as per AR 340-21. It is essential to note that this form is only available in electronic media, ensuring ease of access and distribution.
Purpose and Importance
The primary purpose of DA FORM 5440-33 is to delineate the clinical privileges for urology, ensuring that only qualified personnel are authorized to perform certain medical procedures. This delineation is crucial for maintaining high standards of patient care and safety within military medical facilities.
Key Components of the Form
The form includes several important sections:
- Personal Information: Basic details of the urologist, including name, rank, and service number.
- Clinical Privileges: A comprehensive list of procedures and clinical tasks that the urologist is authorized to perform.
- Approval and Signatures: Sections for approval by medical supervisors and command authorities.
Filling Out DA FORM 5440-33
Filling out DA FORM 5440-33 accurately is critical. Here are the steps involved:
1. Personal Information
The top section requires basic personal details. Ensure all information is current and correctly spelled.
2. Clinical Privileges
This section lists specific urology procedures. The urologist must indicate which procedures they are competent to perform, supported by their training and experience.
3. Approval and Signatures
The completed form must be reviewed and signed by a supervising medical officer. This step verifies the urologist’s qualifications and authorizes their clinical privileges.
Compliance and Privacy
Compliance with the privacy act, as mandated by AR 340-21, is necessary. DA FORM 5440-33 includes sensitive personal and professional information, thus requiring careful handling and confidentiality.
Distribution and Security
This form is unclassified and approved for public release, with distribution code A, meaning distribution is unlimited. The form’s ID number is 990001, and its PIN is 081305, ensuring traceability and proper record-keeping.
Updates and Changes
There are currently no superseded or rescinded versions of DA FORM 5440-33. It remains active and unchanged since its publication date in 2004.
Conclusion
DA FORM 5440-33 – Delineation Of Clinical Privileges – Urology is a fundamental document for maintaining high standards of medical care within the U.S. Army. It ensures that urologists are properly vetted and authorized to perform specific clinical procedures, contributing to the overall safety and effectiveness of military medical services. Proper completion and adherence to guidelines are essential for compliance and maintaining the integrity of the Army’s medical operations.
DA FORM 5440-33 Fillable – Army Pubs 5440-33 PDF DOWNLOAD
