DAFORMFILLABLE.COM | DA FORM 5440-31 Fillable – Army Pubs 5440-31 PDF – DA FORM 5440-31, titled Delineation Of Clinical Privileges – Chiropractic, is a vital document within the U.S. Army’s medical system. Established on February 1, 2004, this form is crucial for outlining the specific clinical privileges granted to chiropractors within military medical facilities.
DA FORM 5440-31 – Delineation Of Clinical Privileges – Chiropractic
| Form Number | DA Form 5440-31 |
| Form Title | Delineation Of Clinical Privileges – Chiropractic |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance
The primary purpose of DA FORM 5440-31 is to ensure that chiropractors practicing within the Army are properly credentialed and granted privileges according to their expertise and training. This form is essential for maintaining high standards of care and ensuring patient safety within military healthcare settings.
Key Components of the Form
DA FORM 5440-31 includes several critical sections that comprehensively cover the chiropractor’s qualifications and the specific procedures they are authorized to perform. These sections include:
- Personal Information: Basic details about the chiropractor, including name, rank, and contact information.
- Professional Qualifications: Educational background, certifications, and professional experience relevant to chiropractic care.
- Requested Privileges: A detailed list of specific clinical activities and procedures the chiropractor seeks permission to perform.
- Approval and Authorization: Signatures from the appropriate medical authorities who review and approve the requested privileges.
Regulatory Framework
The DA FORM 5440-31 operates under the regulatory framework provided by AR 40-68, which governs the credentialing and privileging of healthcare providers in the Army. This regulation ensures that all medical professionals meet the required standards and are competent in their respective fields.
Privacy and Distribution
The form includes several footnotes highlighting its specific requirements:
- Privacy Act Statement (AR 340-21): Ensures that personal information is handled according to privacy laws.
- Electronic Media: The form is exclusively produced and maintained in electronic media, enhancing accessibility and efficiency.
The form’s Security Classification is UNCLASSIFIED, and it is approved for public release with no distribution restrictions, ensuring widespread accessibility for those who need it.
Application and Usage
Who Needs to Use This Form?
DA FORM 5440-31 is primarily used by chiropractors seeking to practice within Army medical facilities. It is also utilized by medical credentialing committees and supervisory personnel who are responsible for verifying and approving clinical privileges.
How to Complete the Form
To complete DA FORM 5440-31, chiropractors must provide detailed and accurate information about their qualifications and desired clinical privileges. This includes:
- Filling Out Personal Information: Accurate and up-to-date personal and professional details.
- Listing Qualifications: Comprehensive details about educational background, certifications, and relevant experience.
- Requesting Specific Privileges: Clear and precise delineation of the clinical procedures and activities the chiropractor is trained and qualified to perform.
- Submitting for Approval: The completed form is then reviewed by the appropriate medical authorities, who evaluate the request and grant approval as deemed appropriate.
Benefits of the Form
DA FORM 5440-31 ensures that only qualified and competent chiropractors are granted clinical privileges within Army medical facilities. This process helps maintain high standards of care, enhances patient safety, and supports the overall effectiveness of the military healthcare system.
Conclusion
DA FORM 5440-31 – Delineation Of Clinical Privileges – Chiropractic is an essential document for chiropractors in the Army, ensuring they are properly credentialed and authorized to perform specific clinical duties. By adhering to the regulatory framework and providing accurate information, chiropractors can obtain the necessary privileges to deliver high-quality care within military medical facilities. This form underscores the Army’s commitment to maintaining excellence and safety in its healthcare services.
DA FORM 5440-31 Fillable – Army Pubs 5440-31 PDF DOWNLOAD
