DAFORMFILLABLE.COM | DA FORM 5440-11 Fillable – Army Pubs 5440-11 PDF – DA FORM 5440-11 – Delineation Of Clinical Privileges-Psychology is a critical document used by the U.S. Army to specify the clinical privileges of psychologists working within the military healthcare system. This form ensures that psychologists are granted the appropriate scope of practice based on their qualifications and competencies.
DA FORM 5440-11 – Delineation Of Clinical Privileges-Psychology
| Form Number | DA Form 5440-11 |
| Form Title | Delineation Of Clinical Privileges-Psychology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5440-11
Publication Details
- Pub/Form Number: DA FORM 5440-11
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Delineation Of Clinical Privileges-Psychology
- Pub/Form Proponent: TSG (The Surgeon General)
- Pub/Form Status: ACTIVE
This form is essential for maintaining the quality and safety of psychological services provided to military personnel. It delineates the specific clinical privileges that a psychologist is authorized to perform.
Purpose and Use
Key Objectives
The primary objective of DA FORM 5440-11 is to outline the clinical activities that a psychologist is permitted to carry out. This form is part of the broader credentialing process governed by AR 40-68, which sets the standards for healthcare professionals within the Army.
- Ensuring Competency: By clearly defining clinical privileges, the Army ensures that only qualified psychologists perform certain activities.
- Standardization: This form helps standardize the scope of practice across different military healthcare facilities.
- Quality Assurance: It contributes to the quality assurance process, ensuring that patients receive care from adequately trained and competent professionals.
Implementation
- Privacy Act Statement: The form requires compliance with the Privacy Act as per AR 340-21.
- Electronic Media: It is only produced and maintained in electronic format, ensuring easy access and updating.
- Distribution: Classified as UNCLASSIFIED and approved for public release, making it widely accessible.
Structure of DA FORM 5440-11
Sections and Components
DA FORM 5440-11 is divided into several sections, each designed to capture specific information about the psychologist’s qualifications and the privileges granted.
- Personal Information: Includes the psychologist’s name, rank, and contact details.
- Qualifications: Details about the psychologist’s education, training, certifications, and experience.
- Requested Privileges: A comprehensive list of clinical activities the psychologist is requesting to perform.
- Approval and Endorsement: Signatures from the credentialing authority and the commanding officer, indicating approval of the requested privileges.
Importance in Military Healthcare
Enhancing Professional Standards
DA FORM 5440-11 plays a vital role in maintaining high professional standards within military healthcare. By delineating clinical privileges, the form helps:
- Mitigate Risks: Reduces the risk of unqualified personnel performing sensitive psychological procedures.
- Improve Patient Outcomes: Ensures that military personnel receive care from competent and qualified psychologists.
- Support Professional Development: Encourages psychologists to pursue additional training and certification to expand their scope of practice.
Compliance and Legal Considerations
Regulatory Framework
The form is mandated by AR 40-68, which sets the credentialing and privileging requirements for healthcare professionals in the Army. Compliance with this regulation is crucial for maintaining the form’s validity and the psychologist’s authority to practice.
- Privacy and Confidentiality: Adherence to the Privacy Act ensures that the personal information of psychologists is protected.
- Electronic Record Keeping: The electronic format facilitates efficient management and reduces the risk of data loss or unauthorized access.
Conclusion
DA FORM 5440-11 – Delineation Of Clinical Privileges-Psychology is a foundational document in the U.S. Army’s effort to ensure that psychologists are appropriately credentialed and privileged. By defining the specific clinical activities that a psychologist can perform, this form helps maintain high standards of care and enhances the overall effectiveness of military healthcare services. Understanding and utilizing this form correctly is essential for both healthcare administrators and psychologists within the Army.
DA FORM 5440-11 Fillable – Army Pubs 5440-11 PDF DOWNLOAD
