DAFORMFILLABLE.COM | DA FORM 5440-4 Fillable – Army Pubs 5440-4 PDF – DA FORM 5440-4, titled Delineation Of Clinical Privileges-Neurology, is a crucial document for healthcare professionals within the military, specifically in the field of neurology. This article aims to provide an in-depth understanding of this form, its purposes, and its applications.
DA FORM 5440-4 – Delineation Of Clinical Privileges-Neurology
| Form Number | DA Form 5440-4 |
| Form Title | Delineation Of Clinical Privileges-Neurology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
What is DA FORM 5440-4?
DA FORM 5440-4 is an official document issued by the Department of the Army. Its primary purpose is to outline the specific clinical privileges granted to neurology practitioners within military medical facilities. This form is pivotal in ensuring that neurology specialists are authorized to perform certain medical procedures and practices according to their qualifications and experience.
Key Details of DA FORM 5440-4
- Pub/Form Number: DA FORM 5440-4
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Delineation Of Clinical Privileges-Neurology
- Pub/Form Proponent: The Surgeon General (TSG)
- Pub/Form Status: Active
- Prescribed Forms/Prescribing Directive: AR 40-68
- Footnotes:
- Requires Privacy Act Statement (AR 340-21)
- Item only produced in electronic media
- Authority: Not superseded or rescinded
- Security Classification: Unclassified
- Distribution Restriction Code: Approved for public release; distribution is unlimited
- Pub/Form IDN: 990001
- Pub/Form PIN: 066527
Purpose and Importance of DA FORM 5440-4
The Delineation Of Clinical Privileges-Neurology form is essential for maintaining high standards of medical care within the military health system. It ensures that only qualified and authorized personnel can perform specialized neurology procedures, thereby safeguarding patient safety and care quality.
Components of DA FORM 5440-4
- Personal Information: This section includes details about the neurology practitioner, such as name, rank, and medical qualifications.
- Clinical Privileges: Detailed listing of the specific neurology procedures and treatments the practitioner is authorized to perform.
- Approval and Authorization: Signatures from the appropriate medical authorities, validating the practitioner’s privileges.
How to Use DA FORM 5440-4
Filling out the DA FORM 5440-4 requires accuracy and thoroughness. Here is a step-by-step guide to ensure the form is correctly completed:
Step-by-Step Guide
- Personal Information: Accurately enter the neurology practitioner’s personal and professional details.
- Privileges Requested: Clearly list the clinical privileges being requested. This should match the practitioner’s training and experience.
- Supervisory Approval: Obtain necessary signatures from supervising medical authorities to validate the requested privileges.
- Review and Submission: Carefully review the form for any errors or omissions before submitting it electronically.
Privacy and Security Considerations
Given that DA FORM 5440-4 includes personal and professional information, it is subject to the Privacy Act Statement as outlined in AR 340-21. This ensures that all data is handled with confidentiality and security.
Distribution and Accessibility
The form is classified as Unclassified and is approved for public release with unlimited distribution. However, it is important to note that the form is only available in electronic media format.
Conclusion
DA FORM 5440-4 – Delineation Of Clinical Privileges-Neurology plays a vital role in the military healthcare system by delineating the scope of practice for neurology professionals. By adhering to the guidelines and accurately completing this form, medical facilities can ensure high standards of care and operational efficiency.
For more detailed information, refer to the prescribing directive AR 40-68 and ensure all privacy and security protocols are followed when handling this form.
By understanding and utilizing DA FORM 5440-4 effectively, healthcare professionals can contribute to the continued excellence and reliability of military medical services.
DA FORM 5440-4 Fillable – Army Pubs 5440-4 PDF DOWNLOAD
