DAFORMFILLABLE.COM | DA FORM 5440-13 Fillable – Army Pubs 5440-13 PDF – DA FORM 5440-13 is a crucial document for general surgeons in the military, delineating their clinical privileges. This form, published on 02/01/2004, ensures that surgeons operate within their qualified scope, maintaining high standards of care and patient safety. As an active form, it is essential for surgeons and administrative personnel to understand its significance and application.
DA FORM 5440-13 – Delineation Of Clinical Privileges-General Surgery
| Form Number | DA Form 5440-13 |
| Form Title | Delineation Of Clinical Privileges-General Surgery |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose of DA FORM 5440-13
The Delineation of Clinical Privileges-General Surgery form is designed to specify the clinical privileges granted to a general surgeon. These privileges are based on the surgeon’s education, training, experience, and demonstrated competence. The form ensures that each surgeon operates within their certified capabilities, promoting quality healthcare and patient safety.
Importance of Clinical Privileges
Clinical privileges define the scope of practice for healthcare providers, ensuring that they perform only those procedures for which they are adequately trained and experienced. This process is vital in the military healthcare system to maintain high standards and protect patient safety.
Authority and Regulation
DA FORM 5440-13 is governed by AR 40-68, which outlines the policies for granting, renewing, and revoking clinical privileges. Compliance with this regulation is mandatory for maintaining the form’s integrity and the quality of care provided by military healthcare facilities.
Privacy and Security
The form requires compliance with the Privacy Act Statement (AR 340-21), ensuring the protection of personal information. Additionally, it is an unclassified document with an A distribution restriction code, indicating it is approved for public release and its distribution is unlimited.
Utilization and Application
Submission and Approval Process
To obtain clinical privileges, a general surgeon must complete DA FORM 5440-13 and submit it for review. The approval process involves a thorough evaluation of the surgeon’s credentials, including education, training, and experience. The form is then reviewed by the privileging authority, which grants the appropriate clinical privileges based on the surgeon’s qualifications.
Electronic Media and Accessibility
DA FORM 5440-13 is produced solely in electronic media, making it easily accessible for military personnel. This electronic format ensures that the form can be quickly updated and distributed, facilitating efficient administration and record-keeping.
Key Sections of DA FORM 5440-13
Personal Information
The form begins with sections to capture the surgeon’s personal and professional information, including name, rank, and contact details. This information is critical for verifying the individual’s identity and qualifications.
Clinical Privileges Requested
In this section, the surgeon specifies the clinical procedures they are requesting privileges for. Each requested privilege must align with the surgeon’s training and demonstrated competence.
Review and Approval
The final section includes the review and approval process, where the privileging authority evaluates the surgeon’s credentials and grants the appropriate privileges. This section ensures that all approvals are documented and verified, maintaining the form’s integrity.
Conclusion
DA FORM 5440-13 is a vital document in the military healthcare system, delineating the clinical privileges of general surgeons. By ensuring that surgeons operate within their qualified scope, this form helps maintain high standards of care and patient safety. Understanding and correctly utilizing this form is essential for both surgeons and administrative personnel in the military healthcare system.
By adhering to the regulations outlined in AR 40-68 and ensuring compliance with the Privacy Act Statement (AR 340-21), military healthcare facilities can effectively manage clinical privileges and uphold the quality of care provided to their patients.
DA FORM 5440-13 Fillable – Army Pubs 5440-13 PDF DOWNLOAD
