DAFORMFILLABLE.COM | DA FORM 5441-11 Fillable – Army Pubs 5441-11 PDF – DA FORM 5441-11, titled Evaluation Of Clinical Privileges – Clinical Psychology, is a critical document used within the United States Army for assessing the clinical competencies of psychologists. This form, effective since February 1, 2004, ensures that clinical psychologists meet the required standards to provide quality care within military facilities. The form is governed by AR 40-68 and is vital for maintaining high standards in military healthcare.
DA FORM 5441-11 – Evaluation Of Clinical Privileges – Clinical Psychology
| Form Number | DA Form 5441-11 |
| Form Title | Evaluation Of Clinical Privileges – Clinical Psychology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5441-11
Purpose and Importance
DA FORM 5441-11 serves to evaluate the clinical privileges of military clinical psychologists. It is a tool for supervisors to assess whether a psychologist possesses the necessary skills, knowledge, and professional behavior to practice effectively within the military health system. The evaluation helps in identifying areas of excellence and areas needing improvement, thereby ensuring that only qualified professionals are granted clinical privileges.
Key Information
- Pub/Form Number: DA FORM 5441-11
- Pub/Form Date: February 1, 2004
- Pub/Form Title: Evaluation Of Clinical Privileges – Clinical Psychology
- 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
- Distribution Restriction Code: A – Approved for public release; distribution is unlimited
Detailed Structure and Usage
Sections of DA FORM 5441-11
DA FORM 5441-11 is structured to cover various aspects of clinical practice, including:
- Personal Information: Details about the psychologist being evaluated, such as name, rank, and duty location.
- Clinical Competencies: Assessment of specific clinical skills and competencies required for clinical psychology practice.
- Professional Behavior: Evaluation of the psychologist’s professional conduct and adherence to ethical standards.
- Supervisor’s Comments: Space for the evaluating supervisor to provide detailed comments and recommendations.
Evaluation Process
The evaluation process involves several steps:
- Self-Assessment: The psychologist completes a self-assessment section to reflect on their own competencies and areas for improvement.
- Supervisor’s Assessment: The supervisor reviews the self-assessment and provides an independent evaluation of the psychologist’s skills and behavior.
- Feedback and Discussion: A formal discussion between the psychologist and the supervisor to review the evaluation and set goals for professional development.
- Documentation and Submission: The completed form is documented and submitted to the appropriate authorities for review and record-keeping.
Compliance and Privacy Considerations
Regulatory Compliance
DA FORM 5441-11 is prescribed by AR 40-68, which outlines the policies and procedures for the administration of clinical privileges within the Army. Adhering to these regulations ensures that evaluations are conducted consistently and fairly across all military healthcare facilities.
Privacy and Security
The form requires a Privacy Act Statement as per AR 340-21 to ensure that the personal information of the psychologists is protected. This compliance with privacy regulations is crucial for maintaining the confidentiality and integrity of the evaluation process.
Accessibility and Distribution
Electronic Media
DA FORM 5441-11 is exclusively produced in electronic media, making it easily accessible for military personnel. This digital format ensures that the form can be efficiently distributed, filled out, and submitted within the Army’s electronic systems.
Public Release
The form is unclassified and has a distribution restriction code of A, meaning it is approved for public release and can be distributed without limitations. This openness supports transparency and allows for broader accessibility and understanding of the evaluation process.
Conclusion
DA FORM 5441-11 – Evaluation Of Clinical Privileges – Clinical Psychology is a fundamental tool in the U.S. Army’s effort to ensure the highest standards of clinical practice among its psychologists. By providing a structured and thorough evaluation process, it helps maintain the quality and reliability of psychological services within the military. Understanding and utilizing this form effectively is essential for supervisors and clinical psychologists aiming to uphold the excellence of military healthcare services.
DA FORM 5441-11 Fillable – Army Pubs 5441-11 PDF DOWNLOAD
