DAFORMFILLABLE.COM | DA FORM 5441-15 Fillable – Army Pubs 5441-15 PDF – DA FORM 5441-15, titled Evaluation Of Clinical Privileges – Certified Nurse Midwife, is a crucial document used within the military healthcare system. This form, with a publication date of February 1, 2004, is designed to evaluate the clinical privileges of certified nurse midwives, ensuring they meet the necessary standards for providing care.
DA FORM 5441-15 – Evaluation Of Clinical Privileges – Certified Nurse Midwife
| Form Number | DA Form 5441-15 |
| Form Title | Evaluation Of Clinical Privileges – Certified Nurse Midwife |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance
The primary purpose of DA FORM 5441-15 is to assess and document the clinical competencies and privileges of certified nurse midwives. This evaluation is essential for maintaining high standards of care within military healthcare facilities. The form is actively used and prescribed by AR 40-68, which governs the quality and competency of medical personnel in the Army.
Structure and Components
Sections of DA FORM 5441-15
DA FORM 5441-15 is divided into several sections, each focusing on different aspects of the nurse midwife’s clinical privileges:
- Personal Information: Includes the name, rank, and contact details of the nurse midwife.
- Clinical Privileges: A detailed list of specific clinical privileges being evaluated.
- Evaluation Criteria: Criteria used to assess the nurse midwife’s competencies, including clinical skills, decision-making abilities, and professional behavior.
- Comments and Recommendations: Space for evaluators to provide additional comments and recommendations regarding the nurse midwife’s privileges.
Completing the Form
The form must be completed by a qualified evaluator, typically a senior medical officer or a healthcare administrator. It requires a thorough review of the nurse midwife’s performance and competencies.
Legal and Privacy Considerations
Privacy Act Statement
As specified in the footnotes of the form, DA FORM 5441-15 requires a Privacy Act Statement in accordance with AR 340-21. This ensures that the personal information collected is protected and used appropriately.
Distribution and Security
The form is unclassified and approved for public release, with no restrictions on distribution. This makes it widely accessible for use within military medical facilities.
Electronic Media and Updates
Accessibility
DA FORM 5441-15 is only produced in electronic media, making it easily accessible for download and use. The Pub/Form IDN for the document is 990001, and its Pub/Form PIN is 066546.
Current Status
The form remains active and is essential for the continuous evaluation of certified nurse midwives in the Army. No superseding or rescinding documents have been issued, indicating its ongoing relevance and importance.
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Conclusion
DA FORM 5441-15 – Evaluation Of Clinical Privileges – Certified Nurse Midwife is a vital tool in the military healthcare system. It ensures that certified nurse midwives possess the necessary competencies to provide high-quality care. By adhering to privacy standards and being readily available in electronic format, the form supports the efficient and effective evaluation of healthcare professionals.
DA FORM 5441-15 Fillable – Army Pubs 5441-15 PDF DOWNLOAD
