DAFORMFILLABLE.COM | DA FORM 5441-2 Fillable – Army Pubs 5441-2 PDF – DA FORM 5441-2, titled “Evaluation of Clinical Privileges-Family Practice,” is a crucial document used within the United States Army Medical Department. This form is designed to evaluate and document the clinical privileges of family practice physicians, ensuring they meet the required standards to provide comprehensive care to military personnel and their families.
DA FORM 5441-2 – Evaluation Of Clinical Privileges-Family Practice
| Form Number | DA Form 5441-2 |
| Form Title | Evaluation Of Clinical Privileges-Family Practice |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Overview of DA FORM 5441-2
Pub/Form Number and Date
The Pub/Form Number for this document is DA FORM 5441-2, and it was published on February 1, 2004. This form remains active and is an essential part of the military’s medical evaluation system.
Pub/Form Title and Proponent
The official title of DA FORM 5441-2 is “Evaluation of Clinical Privileges-Family Practice.” The proponent for this form is TSG (The Surgeon General), highlighting its importance and authority within the Army Medical Department.
Purpose and Usage
The primary purpose of DA FORM 5441-2 is to evaluate the clinical privileges of family practice physicians. This evaluation ensures that the physicians are competent and capable of providing high-quality medical care. The form is prescribed by AR 40-68, which governs the credentialing and privileging process within the Army Medical Department.
Key Features of DA FORM 5441-2
Privacy and Security
- Privacy Act Statement: This form requires a Privacy Act Statement as outlined in AR 340-21, ensuring that personal information is protected.
- Security Classification: The form is classified as unclassified, making it accessible while maintaining confidentiality.
Availability and Distribution
- Electronic Media: DA FORM 5441-2 is only produced in electronic media, reflecting the Army’s move towards digital documentation.
- Distribution: The form is approved for public release, and its distribution is unlimited under the Dist Restriction Code A.
Identifiers
- Pub/Form IDN: 990001
- Pub/Form PIN: 066533
Structure and Components of DA FORM 5441-2
Sections of the Form
DA FORM 5441-2 is structured to comprehensively assess various aspects of a physician’s capabilities. Key sections include:
- Personal Information: Collects basic information about the physician, including name, rank, and unit.
- Professional Qualifications: Details the physician’s education, training, and certifications relevant to family practice.
- Clinical Privileges Evaluation: Provides a thorough evaluation of the physician’s clinical skills and competencies in family practice.
- Performance Review: Includes feedback from supervising physicians and peers regarding the physician’s performance.
- Final Assessment: Summarizes the overall evaluation and determines whether the physician is granted, limited, or denied specific clinical privileges.
Importance of Accurate Documentation
Accurate completion of DA FORM 5441-2 is critical. It ensures that only qualified physicians are authorized to practice, which directly impacts the quality of care provided to military personnel and their families. Errors or omissions in the form can lead to improper privileging, which could have serious consequences.
Best Practices for Using DA FORM 5441-2
Compliance with AR 40-68
Adhering to the guidelines set forth in AR 40-68 is essential for proper use of DA FORM 5441-2. This regulation provides detailed instructions on credentialing and privileging processes, ensuring that evaluations are thorough and standardized.
Ensuring Data Privacy
Given the requirement for a Privacy Act Statement, it is imperative to handle all personal information with the utmost care. Ensure compliance with AR 340-21 to protect the privacy of the physicians being evaluated.
Utilizing Electronic Media
Since the form is only available in electronic media, users should be proficient with digital documentation tools. This ensures that the form is filled out accurately and efficiently, and that records are easily accessible for review and audit purposes.
Conclusion
DA FORM 5441-2 – Evaluation of Clinical Privileges-Family Practice is an essential tool for maintaining high standards of medical care within the Army Medical Department. By thoroughly evaluating the clinical privileges of family practice physicians, the form ensures that only qualified individuals are entrusted with the health and well-being of military personnel and their families. Adhering to the prescribed guidelines and best practices ensures that the evaluation process is effective, fair, and consistent.
DA FORM 5441-2 Fillable – Army Pubs 5441-2 PDF DOWNLOAD
