DAFORMFILLABLE.COM | DA FORM 5441-12 Fillable – Army Pubs 5441-12 PDF – DA FORM 5441-12 is a crucial document in the field of diagnostic radiology within the military. Officially titled Evaluation Of Clinical Privileges – Diagnostic Radiology, this form ensures that practitioners are thoroughly evaluated for their competence and ability to perform diagnostic radiology procedures. First published on February 1, 2004, it remains an active and vital tool prescribed under AR 40-68.
DA FORM 5441-12 – Evaluation Of Clinical Privileges – Diagnostic Radiology
| Form Number | DA Form 5441-12 |
| Form Title | Evaluation Of Clinical Privileges – Diagnostic Radiology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance of DA FORM 5441-12
Ensuring Competence in Diagnostic Radiology
The primary purpose of DA FORM 5441-12 is to evaluate the clinical privileges of diagnostic radiologists within the military. This form assesses whether practitioners possess the necessary skills, knowledge, and experience to perform their duties effectively. This evaluation is critical to maintaining high standards of care and ensuring patient safety.
Compliance with Military Regulations
DA FORM 5441-12 is mandated by AR 40-68, which outlines the policies for clinical privileges and credentials in the Army Medical Department. Compliance with these regulations is essential for the uniform application of standards and the assurance of quality medical care across the military healthcare system.
Key Components of DA FORM 5441-12
Form Structure
DA FORM 5441-12 is designed to be user-friendly and is only produced in electronic media. The form includes several sections that must be completed by the evaluating authority, including:
- Practitioner Information: Details about the practitioner being evaluated.
- Evaluator Information: Information about the individual conducting the evaluation.
- Evaluation Criteria: Specific criteria used to assess the practitioner’s competencies.
- Comments and Recommendations: Space for additional comments and final recommendations regarding the practitioner’s clinical privileges.
Privacy and Security
This form requires a Privacy Act Statement as per AR 340-21, ensuring that all personal information is handled with the utmost confidentiality. The document is classified as UNCLASSIFIED, and it is approved for public release with unlimited distribution, denoted by the Distribution Restriction Code A.
Completing DA FORM 5441-12
Step-by-Step Guide
Practitioner Information
The first section of DA FORM 5441-12 requires detailed information about the practitioner, including their name, rank, and military identification number. This information is crucial for accurate record-keeping and future reference.
Evaluation Criteria
The core of the form involves a detailed evaluation based on specific criteria relevant to diagnostic radiology. Evaluators must thoroughly assess the practitioner’s technical skills, theoretical knowledge, and practical application in various diagnostic procedures.
Comments and Recommendations
Evaluators must provide comprehensive comments on the practitioner’s performance. This section should highlight strengths, identify areas for improvement, and offer recommendations regarding the practitioner’s clinical privileges.
Importance of Accurate Evaluation
Maintaining High Standards
Accurate and thorough evaluations are essential to maintain high standards within the military healthcare system. By ensuring that only competent practitioners are granted clinical privileges, the military can safeguard patient health and enhance the overall quality of care.
Supporting Professional Development
Evaluations using DA FORM 5441-12 also play a crucial role in professional development. Constructive feedback helps practitioners identify areas for improvement and pursue further training or education to enhance their skills.
Conclusion
DA FORM 5441-12 – Evaluation Of Clinical Privileges – Diagnostic Radiology is an essential tool for ensuring the competence and professionalism of diagnostic radiologists in the military. By adhering to the evaluation criteria outlined in this form, the military healthcare system can maintain high standards of care, ensure patient safety, and support the ongoing professional development of its practitioners. Understanding and effectively utilizing DA FORM 5441-12 is crucial for both evaluators and practitioners within the military medical community.
DA FORM 5441-12 Fillable – Army Pubs 5441-12 PDF DOWNLOAD
