DAFORMFILLABLE.COM | DA FORM 5440-1 Fillable – Army Pubs 5440-1 PDF – DA FORM 5440-1, titled Delineation Of Clinical Privileges-Dentistry, is an essential document used within the U.S. Army to outline and specify the clinical privileges granted to dental professionals. This article provides an in-depth overview of this form, its purpose, and its significance in military dentistry.
DA FORM 5440-1 – Delineation Of Clinical Privileges-Dentistry
| Form Number | DA Form 5440-1 |
| Form Title | Delineation Of Clinical Privileges-Dentistry |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5440-1
DA FORM 5440-1 is a standardized form that details the specific clinical privileges that a dentist is authorized to perform within military medical facilities. The form ensures that dental professionals are granted privileges based on their qualifications, training, and experience, maintaining high standards of dental care.
Key Details of DA FORM 5440-1
- Pub/Form Number: DA FORM 5440-1
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Delineation Of Clinical Privileges-Dentistry
- Pub/Form Proponent: TSG (The Surgeon General)
- Pub/Form Status: ACTIVE
- Prescribed Forms/Prescribing Directive: AR 40-68
- Security Classification: UNCLASSIFIED
- Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
Purpose and Importance
The primary purpose of DA FORM 5440-1 is to ensure that dental professionals are performing procedures and duties that align with their verified competencies. This form plays a critical role in:
- Standardizing Dental Care: By specifying the clinical privileges, the form helps maintain consistent and high-quality dental care across all military medical facilities.
- Ensuring Patient Safety: It ensures that only qualified professionals perform specific dental procedures, thereby safeguarding patient health and safety.
- Facilitating Professional Accountability: The form holds dental professionals accountable for their scope of practice, promoting responsibility and adherence to military medical standards.
Sections of DA FORM 5440-1
Personal Information
The form begins with the personal details of the dental professional, including name, rank, and contact information. This section verifies the identity of the individual requesting clinical privileges.
Clinical Privileges Requested
This section outlines the specific clinical privileges the dental professional seeks. These privileges may include general dentistry, oral surgery, orthodontics, periodontics, and other specialized dental procedures. Each privilege is meticulously listed to ensure clarity and precision.
Qualifications and Training
The form requires detailed information on the qualifications and training of the dental professional. This includes educational background, certifications, and any specialized training pertinent to the requested clinical privileges.
Approvals and Signatures
The final section of the form includes approvals and signatures from the relevant authorities. These signatures validate the requested privileges, ensuring they align with the dental professional’s qualifications and the needs of the military medical facility.
Privacy and Security Considerations
According to AR 340-21, DA FORM 5440-1 requires a Privacy Act Statement to protect the personal information of the dental professional. Additionally, the form is produced in electronic media only, enhancing accessibility while maintaining security standards.
Conclusion
DA FORM 5440-1 – Delineation Of Clinical Privileges-Dentistry is a vital document in military dentistry, ensuring that dental professionals perform within their authorized scope of practice. By delineating specific clinical privileges, the form upholds the standards of dental care, ensures patient safety, and promotes professional accountability. Understanding and correctly utilizing this form is crucial for dental professionals serving in the U.S. Army, as it directly impacts the quality and consistency of dental services provided to military personnel.
DA FORM 5440-1 Fillable – Army Pubs 5440-1 PDF DOWNLOAD
