DAFORMFILLABLE.COM | DA FORM 5440-41 Fillable – Army Pubs 5440-41 PDF – DA FORM 5440-41, titled “Delineation Of Clinical Privileges – Physical Medicine And Rehabilitation”, is a critical document used in the medical field, particularly within the military health system. This form, published on February 1, 2004, serves to delineate the specific clinical privileges granted to healthcare providers specializing in Physical Medicine and Rehabilitation (PM&R). Managed under the authority of TSG and prescribed by AR 40-68, this form ensures that medical professionals operate within their scope of practice, maintaining the highest standards of patient care and safety.
DA FORM 5440-41 – Delineation Of Clinical Privileges – Physical Medicine And Rehabilitation
| Form Number | DA Form 5440-41 |
| Form Title | Delineation Of Clinical Privileges – Physical Medicine And Rehabilitation |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance of DA FORM 5440-41
Ensuring Competence and Safety
The primary purpose of DA FORM 5440-41 is to define the clinical privileges that a practitioner in the field of Physical Medicine and Rehabilitation is authorized to perform. This process is essential for maintaining a high standard of care and ensuring that all procedures and treatments provided by healthcare professionals are within their competency. By clearly delineating these privileges, the form helps to prevent medical errors and enhance patient safety.
Compliance with Regulations
The use of DA FORM 5440-41 is mandated by AR 40-68, which outlines the policies and procedures for granting clinical privileges within the Army Medical Department. Compliance with this directive is crucial for legal and regulatory reasons, ensuring that all healthcare activities are performed within the bounds of the law and institutional policies.
Components of DA FORM 5440-41
Clinical Privileges Section
The heart of DA FORM 5440-41 is the section where specific clinical privileges are listed. These privileges cover a wide range of procedures and treatments that a PM&R specialist is qualified to perform. This section must be filled out with precision, detailing each allowed procedure to ensure there is no ambiguity regarding the scope of practice.
Privacy Act Statement
Given the sensitive nature of medical information, DA FORM 5440-41 includes a Privacy Act Statement as required by AR 340-21. This statement informs the practitioner of the legal protections surrounding their personal and professional data, ensuring confidentiality and compliance with privacy regulations.
Utilization and Distribution
Electronic Media and Accessibility
The form is only produced in electronic media, facilitating easy access and distribution. This electronic format ensures that the form can be efficiently disseminated across various military medical facilities, promoting uniformity and ease of use.
Public Release and Distribution
Classified as UNCLASSIFIED and with a Distribution Restriction Code A, DA FORM 5440-41 is approved for public release, meaning that its distribution is unlimited. This unrestricted access underscores the transparency and accessibility of the form, ensuring that all relevant personnel can obtain and utilize it as needed.
Conclusion
DA FORM 5440-41 – Delineation Of Clinical Privileges – Physical Medicine And Rehabilitation is a pivotal document within the military health system, ensuring that PM&R specialists are granted the appropriate clinical privileges in accordance with their qualifications and competencies. By adhering to the guidelines set forth in AR 40-68 and incorporating a robust Privacy Act Statement, this form plays a crucial role in maintaining high standards of patient care and regulatory compliance. The electronic format and unrestricted distribution further enhance its utility, making it a cornerstone of medical practice within the Army Medical Department.
DA FORM 5440-41 Fillable – Army Pubs 5440-41 PDF DOWNLOAD
