DAFORMFILLABLE.COM | DA FORM 5440-5 Fillable – Army Pubs 5440-5 PDF – DA FORM 5440-5, also known as the Delineation Of Clinical Privileges-Obstetrics And Gynecology, is a crucial document in the field of military medical practice. It defines the clinical privileges granted to obstetricians and gynecologists within the Army Medical Department, ensuring that only qualified professionals provide care in these specialized areas.
DA FORM 5440-5 – Delineation Of Clinical Privileges-Obstetrics And Gynecology
| Form Number | DA Form 5440-5 |
| Form Title | Delineation Of Clinical Privileges-Obstetrics And Gynecology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5440-5
Pub/Form Number: DA FORM 5440-5
Pub/Form Date: February 1, 2004
Pub/Form Title: Delineation Of Clinical Privileges-Obstetrics And Gynecology
Pub/Form Proponent: The Surgeon General (TSG)
Pub/Form Status: Active
Prescribed Forms/Prescribing Directive: AR 40-68
Footnotes:
- 42: Item only produced in electronic media
- 14: Requires Privacy Act Statement (AR 340-21)
Security Classification: Unclassified
Dist Restriction Code: A (Approved for public release; distribution is unlimited)
Pub/Form IDN: 990001
Pub/Form PIN: 066526
Purpose and Importance of DA FORM 5440-5
Ensuring Qualified Medical Practice
DA FORM 5440-5 plays a vital role in the Army Medical Department by defining the specific clinical privileges for obstetricians and gynecologists. This ensures that only professionals who meet the necessary qualifications and standards can perform certain medical procedures and provide care in these specialized areas. The form helps maintain high standards of medical care and patient safety.
Compliance with AR 40-68
This form is prescribed by AR 40-68, which outlines the policies and procedures for credentialing and granting clinical privileges to healthcare providers within the Army. Adhering to this regulation is crucial for maintaining the integrity and effectiveness of military medical services.
Privacy and Security Considerations
DA FORM 5440-5 requires a Privacy Act Statement as per AR 340-21, ensuring that the personal information of healthcare providers is protected. The form is unclassified and approved for public release, making it accessible for those who need to use it without compromising security.
Structure and Components of DA FORM 5440-5
Personal and Professional Information
The form collects detailed information about the healthcare provider, including:
- Name
- Rank
- Social Security Number
- Medical Qualifications
Delineation of Privileges
The core of DA FORM 5440-5 is the delineation of specific clinical privileges. This section lists various procedures and services that an obstetrician or gynecologist is authorized to perform. It ensures that each provider’s scope of practice is clearly defined and based on their qualifications and experience.
Approval and Validation
The form includes sections for validation and approval by authorized personnel. This typically involves:
- Signature of the Chief of Service
- Signature of the Credentialing Authority
- Date of Approval
These signatures confirm that the privileges have been reviewed and granted by the appropriate authorities.
Utilizing DA FORM 5440-5 in Professional Practice
Submission and Review Process
Healthcare providers must complete DA FORM 5440-5 and submit it for review. The review process involves verifying the provider’s qualifications and ensuring they meet the necessary standards for the privileges they are requesting. This rigorous process helps maintain high standards of care within the Army Medical Department.
Ongoing Monitoring and Updates
Privileges granted through DA FORM 5440-5 are not permanent. They are subject to regular review and can be updated or revoked based on the provider’s performance, continuing education, and changes in medical standards. This ensures that the privileges remain current and relevant to the provider’s abilities and the needs of the military healthcare system.
Conclusion
DA FORM 5440-5 is an essential tool in maintaining the quality and safety of obstetrics and gynecology care within the Army Medical Department. By clearly delineating clinical privileges and ensuring compliance with regulatory standards, it helps safeguard the health and well-being of military personnel and their families. Understanding and utilizing this form effectively is crucial for healthcare providers in this field.
For more detailed information on DA FORM 5440-5, refer to the prescribing directive AR 40-68 and ensure compliance with all relevant policies and procedures.
DA FORM 5440-5 Fillable – Army Pubs 5440-5 PDF DOWNLOAD
