DAFORMFILLABLE.COM | DA FORM 5440-12 Fillable – Army Pubs 5440-12 PDF – DA FORM 5440-12 is a crucial document used in the medical field, specifically within the United States Army. This form is essential for the delineation of clinical privileges in diagnostic radiology, ensuring that medical professionals are properly credentialed to perform various radiological procedures. This article provides an in-depth understanding of DA FORM 5440-12, its purpose, and its importance in the medical community.
DA FORM 5440-12 – Delineation Of Clinical Privileges-Diagnostic Radiology
| Form Number | DA Form 5440-12 |
| Form Title | Delineation Of Clinical Privileges-Diagnostic Radiology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
What is DA FORM 5440-12?
DA FORM 5440-12, titled Delineation Of Clinical Privileges-Diagnostic Radiology, is an official document used to specify the clinical privileges granted to diagnostic radiologists within the Army. This form is governed by the Army Regulation AR 40-68, which outlines the procedures for credentialing and granting clinical privileges to healthcare providers.
Key Details of DA FORM 5440-12
- Pub/Form Number: DA FORM 5440-12
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Delineation Of Clinical Privileges-Diagnostic Radiology
- Pub/Form Proponent: The Surgeon General (TSG)
- Pub/Form Status: Active
- Prescribed Forms/Prescribing Directive: AR 40-68
- Footnotes: Requires Privacy Act Statement (AR 340-21); Item only produced in electronic media
- Security Classification: Unclassified
- Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
- Pub/Form IDN: 990001
- Pub/Form PIN: 066514
Purpose of DA FORM 5440-12
The primary purpose of DA FORM 5440-12 is to ensure that only qualified diagnostic radiologists are granted the authority to perform specific radiological procedures. This form delineates the scope of practice and the specific clinical privileges that a radiologist is authorized to exercise. It serves as a formal record that helps maintain high standards of patient care and safety within military medical facilities.
Components of DA FORM 5440-12
Clinical Privileges
The form details the specific clinical privileges granted to the radiologist, which may include but are not limited to:
- Diagnostic imaging procedures such as X-rays, CT scans, MRI, and ultrasound.
- Interventional radiology techniques like biopsies, catheter placements, and angiographies.
- Nuclear medicine procedures involving radioactive materials for diagnostic purposes.
Credentialing Information
DA FORM 5440-12 includes sections for documenting the radiologist’s qualifications, including:
- Education and Training: Details of medical education, residency, and any specialized training in diagnostic radiology.
- Certification and Licensure: Information on board certification and state medical licenses.
- Professional Experience: A record of the radiologist’s professional experience and prior positions held.
Authorization and Approval
The form must be reviewed and approved by the appropriate medical authorities within the Army. This includes signatures from:
- The Chief of Radiology: Confirms the radiologist’s competence and suitability for the specified clinical privileges.
- The Medical Facility Commander: Provides the final approval and authorization for the clinical privileges.
Importance of DA FORM 5440-12
Ensuring Quality Care
By clearly defining the clinical privileges of diagnostic radiologists, DA FORM 5440-12 helps ensure that patients receive care from professionals who are properly trained and qualified. This contributes to maintaining high standards of patient safety and quality of care.
Compliance with Regulations
The form ensures compliance with Army regulations (AR 40-68), which mandate proper credentialing and privileging of healthcare providers. This compliance is crucial for maintaining the integrity and trustworthiness of military medical services.
Legal and Administrative Documentation
As an official document, DA FORM 5440-12 serves as a legal record that can be used for administrative and legal purposes. It helps protect the interests of both the radiologist and the medical facility by providing a clear record of the granted privileges.
Conclusion
DA FORM 5440-12 plays a vital role in the Army’s medical credentialing process, ensuring that diagnostic radiologists are properly authorized to perform their duties. By delineating clinical privileges, this form helps maintain high standards of patient care, compliance with regulations, and serves as an important legal document. Understanding the significance and proper use of DA FORM 5440-12 is essential for medical professionals and administrative personnel within the military healthcare system.
By adhering to SEO best practices, this article aims to provide comprehensive and informative content for those seeking to understand DA FORM 5440-12 and its role in diagnostic radiology within the Army.
DA FORM 5440-12 Fillable – Army Pubs 5440-12 PDF DOWNLOAD
