DAFORMFILLABLE.COM | DA FORM 5440-10 Fillable – Army Pubs 5440-10 PDF – DA FORM 5440-10 – Delineation Of Clinical Privileges-Psychiatry is a critical document used in the medical field, specifically within military settings, to outline and authorize the clinical privileges of psychiatry professionals. This form ensures that only qualified personnel are granted the necessary privileges to provide psychiatric care. Issued by the U.S. Army, it plays a vital role in maintaining high standards of psychiatric care.
DA FORM 5440-10 – Delineation Of Clinical Privileges-Psychiatry
| Form Number | DA Form 5440-10 |
| Form Title | Delineation Of Clinical Privileges-Psychiatry |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5440-10
Form Details
Pub/Form Number: DA FORM 5440-10
Pub/Form Date: 02/01/2004
Pub/Form Title: Delineation Of Clinical Privileges-Psychiatry
Pub/Form Proponent: TSG (The Surgeon General)
Pub/Form Status: ACTIVE
Prescribed Forms/Prescribing Directive: AR 40-68
Footnotes:
- 14 – Requires Privacy Act Statement (AR 340-21)
- 42 – Item only produced in electronic media
Security Classification: UNCLASSIFIED
Dist Restriction Code: A – Approved for public release; distribution is unlimited
Pub/Form IDN: 990001
Pub/Form PIN: 066521
Purpose of DA FORM 5440-10
The primary purpose of DA FORM 5440-10 is to delineate the specific clinical privileges granted to psychiatry professionals. This ensures that practitioners operate within their scope of competence, promoting safety and quality in psychiatric care.
Understanding the Components of DA FORM 5440-10
Clinical Privileges
Clinical Privileges refer to the specific activities that a psychiatry professional is authorized to perform. These activities are outlined based on the individual’s qualifications, training, and experience. The form categorizes these privileges to ensure clarity and compliance with military standards.
Required Documentation
When filling out DA FORM 5440-10, it is crucial to provide comprehensive documentation. This includes proof of education, certifications, and previous clinical experience. Accurate documentation ensures that the privileges granted align with the professional’s competencies.
Importance of DA FORM 5440-10 in Psychiatry
Ensuring Competence
By using DA FORM 5440-10, the military can ensure that only qualified psychiatry professionals are granted the necessary privileges. This form acts as a safeguard, ensuring that psychiatric care provided within military facilities meets the highest standards of quality and safety.
Compliance with Regulations
The form is prescribed by AR 40-68, which sets the standards for the credentialing and privileging of healthcare providers. Compliance with these regulations is mandatory, making DA FORM 5440-10 a critical component in maintaining regulatory adherence.
Completing DA FORM 5440-10
Steps to Fill Out the Form
- Personal Information: Include the psychiatry professional’s name, rank, and contact information.
- Qualifications: Document educational background, certifications, and relevant training.
- Clinical Privileges Requested: List the specific privileges the professional is seeking.
- Approval: The form must be reviewed and approved by the relevant authority, typically a senior medical officer.
Electronic Submission
Footnote 42 indicates that DA FORM 5440-10 is only produced in electronic media. This means the form must be completed and submitted electronically, ensuring efficiency and accuracy in processing.
Conclusion
DA FORM 5440-10 – Delineation Of Clinical Privileges-Psychiatry is an essential document in the military healthcare system. It ensures that psychiatry professionals are properly credentialed and authorized to provide care, maintaining high standards of patient safety and regulatory compliance. By understanding and properly completing this form, military medical facilities can continue to deliver exceptional psychiatric care.
For more detailed information or to access the form, please refer to the official military publications or the prescribing directive AR 40-68.
DA FORM 5440-10 Fillable – Army Pubs 5440-10 PDF DOWNLOAD
