DAFORMFILLABLE.COM | DA FORM 5440-28 Fillable – Army Pubs 5440-28 PDF – DA FORM 5440-28, titled “Delineation of Clinical Privileges – Social Work,” is a crucial document within the U.S. Army medical system. It serves to define and authorize the specific clinical privileges granted to social workers. This form ensures that social workers possess the appropriate qualifications and permissions to perform their duties effectively within military medical facilities.
DA FORM 5440-28 – Delineation Of Clinical Privileges – Social Work
| Form Number | DA Form 5440-28 |
| Form Title | Delineation Of Clinical Privileges – Social Work |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5440-28
DA FORM 5440-28 was issued on February 1, 2004, and is currently active. The form is prescribed by AR 40-68, which governs the credentialing and privileging of healthcare personnel within the Army. It is a vital document used to delineate the clinical roles and responsibilities of social workers.
Purpose and Importance
The primary purpose of DA FORM 5440-28 is to ensure that social workers in the Army are adequately credentialed to perform specific clinical duties. This form helps in maintaining high standards of care by verifying that social workers have the necessary skills and qualifications.
Components of the Form
The DA FORM 5440-28 includes several key sections:
- Personal Information: This section captures the personal details of the social worker, including their name, rank, and contact information.
- Clinical Privileges: Detailed listing of the clinical activities the social worker is authorized to perform.
- Qualifications: Documentation of the social worker’s education, training, and experience.
- Approval and Signatures: This section includes the signatures of the approving authorities, ensuring the form’s validity.
Prescribing Directive and Privacy Act
The form is prescribed by AR 40-68, which is the Army Regulation that outlines the credentialing and privileging of healthcare professionals. A notable footnote associated with DA FORM 5440-28 is that it requires a Privacy Act Statement in accordance with AR 340-21. This ensures that all personal information is handled in compliance with privacy laws.
Electronic Media and Distribution
DA FORM 5440-28 is exclusively produced in electronic media, making it easily accessible and distributable within the Army’s healthcare system. The form has a distribution restriction code A, meaning it is approved for public release and its distribution is unlimited. This ensures transparency and accessibility for those who need to utilize this form.
Security and Classification
The form is classified as unclassified, ensuring that it does not contain sensitive information that requires special handling. This classification facilitates ease of access and use within the military healthcare system.
Authority and Changes
The DA FORM 5440-28 does not supersede or replace any other publication or form. It remains a standalone document specific to the delineation of clinical privileges for social workers.
Key Considerations for Use
When using DA FORM 5440-28, it is essential to ensure that all sections are completed accurately and that the form is signed by the appropriate authorities. This guarantees that the social worker’s clinical privileges are clearly defined and legally recognized.
Conclusion
DA FORM 5440-28 is a vital document for ensuring that social workers within the Army are properly credentialed and authorized to perform their clinical duties. By clearly delineating the clinical privileges, this form helps maintain high standards of care and professionalism within military medical facilities.
For more information on the use and significance of DA FORM 5440-28, refer to AR 40-68 and ensure compliance with all relevant regulations and guidelines.
DA FORM 5440-28 Fillable – Army Pubs 5440-28 PDF DOWNLOAD
