DAFORMFILLABLE.COM | DA FORM 5440 Fillable – Army Pubs 5440 PDF – DA FORM 5440 – Delineation of Clinical Privileges-Anesthesia is a crucial document utilized within military medical facilities to define the clinical privileges of anesthesia providers. This article aims to provide a comprehensive overview of this form, its purpose, and its significance in maintaining high standards of patient care in military healthcare settings.
DA FORM 5440 – Delineation Of Clinical Privileges-Anesthesia
| Form Number | DA Form 5440 |
| Form Title | Delineation Of Clinical Privileges-Anesthesia |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
What is DA FORM 5440?
DA FORM 5440, officially titled Delineation of Clinical Privileges-Anesthesia, was published on February 1, 2004. This form is actively used and maintained by the TSG (The Surgeon General). It falls under the guidelines of AR 40-68, which governs the clinical quality management and delineation of clinical privileges within the Army Medical Department.
Key Details of DA FORM 5440
- Pub/Form Number: DA FORM 5440
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Delineation of Clinical Privileges-Anesthesia
- Pub/Form Proponent: TSG
- Pub/Form Status: Active
- Prescribed Forms/Prescribing Directive: AR 40-68
- Footnotes:
- 42-Item only produced in electronic media
- 14-Requires Privacy Act Statement (AR 340-21)
- Security Classification: Unclassified
- Dist Restriction Code: A Approved for public release; distribution is unlimited
- Pub/Form IDN: 990001
- Pub/Form PIN: 066992
Purpose of DA FORM 5440
The primary purpose of DA FORM 5440 is to ensure that anesthesia providers in military medical facilities are granted clinical privileges that are commensurate with their training, experience, and current competency. This form serves as a standardized tool for delineating the scope of practice for anesthesia professionals, thereby enhancing the safety and quality of anesthesia services provided to military personnel and their families.
Importance of Clinical Privileges
Clinical privileges are the specific services and procedures that a healthcare provider is authorized to perform within a healthcare facility. For anesthesia providers, these privileges may include general anesthesia, regional anesthesia, and various sedation techniques. The delineation of these privileges is essential for maintaining high standards of patient care and ensuring that providers are operating within their scope of competence.
Structure and Content of DA FORM 5440
DA FORM 5440 is structured to capture detailed information about the anesthesia provider’s qualifications and the specific privileges they are authorized to perform. The form includes sections for documenting:
- Provider Information: Name, rank, and contact details.
- Qualifications: Education, training, certification, and licensure.
- Requested Privileges: Specific anesthesia services and procedures the provider is seeking to be authorized to perform.
- Approval Signatures: Signatures from the privileging authority and the anesthesia provider, indicating mutual agreement on the delineated privileges.
Privacy and Security
The form includes a Privacy Act Statement, as required by AR 340-21, to ensure that the personal information of the provider is protected. Additionally, the form is unclassified and approved for public release, with no restrictions on its distribution.
Implementation and Usage
DA FORM 5440 is used exclusively in electronic media, making it easily accessible and manageable within military healthcare systems. This electronic format also facilitates updates and revisions, ensuring that the delineation of privileges remains current and reflective of the provider’s capabilities.
Ensuring Compliance
Healthcare facilities must ensure that DA FORM 5440 is completed accurately and thoroughly for each anesthesia provider. Regular reviews and updates of the form are necessary to accommodate any changes in the provider’s qualifications or the scope of services they are authorized to perform.
Conclusion
DA FORM 5440 – Delineation of Clinical Privileges-Anesthesia plays a vital role in defining the clinical scope of anesthesia providers within military healthcare facilities. By delineating specific privileges based on the provider’s qualifications, this form helps maintain high standards of patient care and ensures that anesthesia services are delivered safely and effectively. Understanding the purpose and structure of DA FORM 5440 is essential for healthcare administrators and providers in the military healthcare system.
By adhering to the guidelines and requirements outlined in DA FORM 5440, military healthcare facilities can ensure that their anesthesia providers are operating within their scope of competence, thereby enhancing the overall quality of care provided to military personnel and their families.
DA FORM 5440 Fillable – Army Pubs 5440 PDF DOWNLOAD
