DAFORMFILLABLE.COM | DA FORM 5440-36 Fillable – Army Pubs 5440-36 PDF – DA FORM 5440-36, titled Delineation of Clinical Privileges – Audiology, is a crucial document in the medical field, particularly for audiology professionals. This form, effective since February 1, 2004, plays a significant role in defining the scope of practice for audiologists within military healthcare settings. This article aims to provide an in-depth understanding of DA FORM 5440-36, highlighting its purpose, structure, and importance.
DA FORM 5440-36 – Delineation Of Clinical Privileges – Audiology
| Form Number | DA Form 5440-36 |
| Form Title | Delineation Of Clinical Privileges – Audiology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose of DA FORM 5440-36
The primary objective of DA FORM 5440-36 is to delineate the clinical privileges of audiologists, specifying the types of procedures and treatments they are authorized to perform. This ensures that audiologists operate within their scope of competence and training, thereby maintaining high standards of patient care and safety.
Key Features of DA FORM 5440-36
Pub/Form Information
- Pub/Form Number: DA FORM 5440-36
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Delineation of Clinical Privileges – Audiology
- Pub/Form Proponent: TSG (The Surgeon General)
- Pub/Form Status: ACTIVE
Prescribing Directive
DA FORM 5440-36 is prescribed by AR 40-68, which outlines the policies and procedures for credentialing and privileging health care providers. This regulation ensures that only qualified and competent professionals are granted clinical privileges.
Privacy and Distribution
The form requires a Privacy Act Statement (as per AR 340-21) to protect the personal information of the providers. Additionally, it is only produced in electronic media, ensuring easy access and distribution while maintaining data security.
- Security Classification: UNCLASSIFIED
- Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
- Pub/Form IDN: 990001
- Pub/Form PIN: 081308
Structure of DA FORM 5440-36
Sections and Content
The form is divided into several sections, each detailing specific information regarding the audiologist’s qualifications and the clinical procedures they are privileged to perform. These sections typically include:
Personal and Professional Information
This section captures the audiologist’s personal details, including their name, rank, and contact information, as well as their professional qualifications and certifications.
Scope of Practice
In this section, the specific clinical privileges granted to the audiologist are listed. This includes various diagnostic and therapeutic procedures, such as hearing assessments, hearing aid fittings, and balance disorder evaluations.
Supervisory and Approval Signatures
The form requires signatures from supervising authorities and the approving officer, ensuring that the audiologist’s privileges are reviewed and authorized by competent officials.
Importance of DA FORM 5440-36
Ensuring Competence and Safety
By clearly delineating the clinical privileges of audiologists, DA FORM 5440-36 helps maintain high standards of care. It ensures that audiologists are only performing procedures for which they are trained and competent, thereby reducing the risk of medical errors and enhancing patient safety.
Facilitating Credentialing and Privileging
The form plays a critical role in the credentialing and privileging process within military healthcare facilities. It provides a standardized way to document and verify the qualifications and competencies of audiologists, ensuring consistency and reliability in the granting of clinical privileges.
Conclusion
DA FORM 5440-36 – Delineation of Clinical Privileges – Audiology is a vital document that helps define and regulate the scope of practice for audiologists in military healthcare settings. By adhering to the guidelines and requirements outlined in this form, healthcare facilities can ensure that audiologists provide safe and effective care to their patients.
For individuals seeking more information or needing to utilize this form, it is recommended to refer to the prescribing directive AR 40-68 and ensure compliance with all relevant regulations and privacy requirements.
DA FORM 5440-36 Fillable – Army Pubs 5440-36 PDF DOWNLOAD
