DAFORMFILLABLE.COM | DA FORM 5441-39 Fillable – Army Pubs 5441-39 PDF – DA FORM 5441-39 is a crucial document for the evaluation of clinical privileges in the field of nuclear medicine. This form, published by the Department of the Army, serves as a standardized method for assessing the competencies and qualifications of medical professionals. Understanding the specifics of this form is essential for ensuring proper credentialing and maintaining high standards of patient care.
DA FORM 5441-39 – Evaluation Of Clinical Privileges – Nuclear Medicine
| Form Number | DA Form 5441-39 |
| Form Title | Evaluation Of Clinical Privileges – Nuclear Medicine |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5441-39
Publication Details
DA FORM 5441-39 was issued on February 1, 2004, and remains in active status. It is produced by TSG (The Surgeon General) and falls under the guidelines prescribed by AR 40-68. This form is classified as unclassified and has a distribution restriction code of A, meaning it is approved for public release with unlimited distribution.
Purpose and Importance
The primary purpose of DA FORM 5441-39 is to evaluate the clinical privileges of medical professionals specializing in nuclear medicine. This form ensures that individuals have the necessary skills, knowledge, and experience to provide high-quality care in this specialized field. By adhering to a standardized evaluation process, the Army can maintain a consistent level of care across its medical facilities.
Components of DA FORM 5441-39
Sections of the Form
DA FORM 5441-39 comprises several sections that cover various aspects of a medical professional’s qualifications and competencies. These sections include:
- Personal Information: This section captures basic details about the medical professional, such as name, rank, and contact information.
- Training and Education: This part documents the individual’s educational background and specialized training in nuclear medicine.
- Clinical Experience: This section records the professional’s practical experience, including the types and numbers of procedures performed.
- Performance Evaluation: Supervisors provide a detailed assessment of the individual’s performance, highlighting strengths and areas for improvement.
- Competency Validation: This section confirms that the medical professional has demonstrated the required competencies to practice nuclear medicine safely and effectively.
Privacy and Security Considerations
As the form includes sensitive personal and professional information, it is essential to adhere to privacy and security guidelines. According to AR 340-21, the form requires a Privacy Act Statement to ensure that individuals’ information is protected. The form is also only produced in electronic media to streamline access and management.
Utilizing DA FORM 5441-39
Completing the Form
To complete DA FORM 5441-39, the medical professional must provide accurate and detailed information in each section. Supervisors and credentialing officers must then review and validate this information to ensure its accuracy. It is crucial to follow the prescribed guidelines and use the form as part of a comprehensive evaluation process.
Submission and Approval
Once completed, the form should be submitted to the appropriate authorities for review. The approval process involves multiple levels of scrutiny to ensure that only qualified individuals receive clinical privileges in nuclear medicine. This thorough process helps maintain the highest standards of care within the Army’s medical facilities.
Conclusion
DA FORM 5441-39 plays a vital role in the evaluation of clinical privileges for medical professionals in nuclear medicine. By providing a standardized method for assessing qualifications and competencies, the form ensures that only highly skilled and knowledgeable individuals are granted privileges to practice in this specialized field. Adhering to the guidelines and completing the form accurately is essential for maintaining high standards of patient care and safety.
Understanding and utilizing DA FORM 5441-39 effectively can significantly impact the quality of medical services provided within the Army, ultimately contributing to better patient outcomes and overall mission success.
DA FORM 5441-39 Fillable – Army Pubs 5441-39 PDF DOWNLOAD
