DAFORMFILLABLE.COM | DA FORM 5440-34 Fillable – Army Pubs 5440-34 PDF – DA FORM 5440-34, officially titled Delineation Of Clinical Privileges – Behavioral Health Practitioner, is a critical document used within the U.S. Army to outline and specify the clinical privileges of behavioral health practitioners. This form, dated February 1, 2004, ensures that only qualified personnel are authorized to perform specific behavioral health services, safeguarding the quality of care provided to service members.
DA FORM 5440-34 – Delineation Of Clinical Privileges – Behavioral Health Practitioner
| Form Number | DA Form 5440-34 |
| Form Title | Delineation Of Clinical Privileges – Behavioral Health Practitioner |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance
What is DA FORM 5440-34?
DA FORM 5440-34 serves as an official record that delineates the clinical privileges granted to behavioral health practitioners. It is designed to ensure that practitioners are both qualified and authorized to perform certain clinical tasks. The form is maintained by the The Surgeon General (TSG) and is crucial in maintaining high standards of medical care in the military.
Why is DA FORM 5440-34 Important?
The importance of DA FORM 5440-34 lies in its role in the credentialing and privileging process. This process ensures that only competent and trained individuals are allowed to provide behavioral health services. By clearly specifying what each practitioner is permitted to do, this form helps to protect patients and maintain the integrity of the healthcare system.
Key Features of DA FORM 5440-34
Publication and Status
- Publication Number: DA FORM 5440-34
- Publication Date: 02/01/2004
- Status: Active
- Security Classification: Unclassified
- Distribution: Approved for public release; distribution is unlimited
Regulatory Framework
DA FORM 5440-34 is prescribed by AR 40-68, which outlines the requirements for the credentialing and privileging of healthcare providers within the Army. The form also requires a Privacy Act Statement as mandated by AR 340-21, ensuring that the personal information of healthcare providers is protected.
Accessibility
This form is only produced in electronic media, making it easily accessible for those who need to use it. The electronic format helps streamline the process of credentialing and privileging, ensuring that it is both efficient and secure.
Completing DA FORM 5440-34
Sections of the Form
DA FORM 5440-34 is divided into several sections, each designed to capture specific information about the behavioral health practitioner’s qualifications and the scope of their clinical privileges. Key sections include:
- Personal Information: Details about the practitioner, including name, rank, and contact information.
- Professional Qualifications: Education, training, certifications, and licensure information.
- Clinical Privileges Requested: Specific clinical tasks and procedures the practitioner is seeking privileges for.
- Approval and Authorization: Signatures from supervising authorities to grant the requested privileges.
Submission and Approval Process
To complete DA FORM 5440-34, the behavioral health practitioner must fill out the relevant sections and submit the form to their supervising authority. The form is then reviewed to ensure that the practitioner meets all necessary qualifications. Once reviewed, the form is signed and dated by the appropriate authorities, officially granting the specified clinical privileges.
Implications of DA FORM 5440-34
For Practitioners
For behavioral health practitioners, having a completed and approved DA FORM 5440-34 is essential for practicing within the military healthcare system. It serves as proof of their qualifications and the scope of their authorized clinical activities.
For Military Healthcare System
The use of DA FORM 5440-34 helps maintain a high standard of care within the military healthcare system. By ensuring that only qualified individuals are granted clinical privileges, the form helps to protect the health and well-being of service members.
Conclusion
DA FORM 5440-34 – Delineation Of Clinical Privileges – Behavioral Health Practitioner is a vital document in the U.S. Army’s healthcare system. It ensures that behavioral health practitioners are properly credentialed and authorized to perform specific clinical tasks. By following the procedures outlined in this form, the Army can maintain high standards of care and safeguard the health of its service members. For those involved in military healthcare, understanding and properly utilizing DA FORM 5440-34 is essential to their professional responsibilities and the overall mission of the military healthcare system.
DA FORM 5440-34 Fillable – Army Pubs 5440-34 PDF DOWNLOAD
