DAFORMFILLABLE.COM | DA FORM 5441-40 Fillable – Army Pubs 5441-40 PDF – DA FORM 5441-40 – Evaluation Of Clinical Privileges – Therapeutic Radiology is a crucial document used within the U.S. Army to assess the clinical competencies of healthcare providers specializing in therapeutic radiology. This form ensures that professionals meet the required standards to deliver safe and effective radiological treatments.
DA FORM 5441-40 – Evaluation Of Clinical Privileges – Therapeutic Radiology
| Form Number | DA Form 5441-40 |
| Form Title | Evaluation Of Clinical Privileges – Therapeutic Radiology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Publication Details
- Pub/Form Number: DA FORM 5441-40
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Evaluation Of Clinical Privileges – Therapeutic Radiology
- Pub/Form Proponent: TSG (The Surgeon General)
- Pub/Form Status: Active
- Prescribed Forms/Prescribing Directive: AR 40-68
- Footnotes: Requires Privacy Act Statement (AR 340-21), Item Only Produced in Electronic Media
- Security Classification: Unclassified
- Distribution Restriction Code: A – Approved for public release; distribution is unlimited
- Pub/Form IDN: 990001
- Pub/Form PIN: 081281
Purpose and Importance
Assessing Clinical Competencies
The primary purpose of DA FORM 5441-40 is to evaluate the clinical privileges of healthcare providers in the field of therapeutic radiology. This evaluation ensures that these professionals possess the necessary skills and knowledge to perform their duties effectively. The form is essential for maintaining high standards of patient care and safety within military medical facilities.
Compliance with AR 40-68
This form is prescribed by AR 40-68, which outlines the policies and procedures for granting clinical privileges to healthcare providers. Compliance with this regulation is mandatory to ensure that only qualified individuals are authorized to provide therapeutic radiological services.
Structure and Content
Sections of the Form
DA FORM 5441-40 is structured to cover various aspects of a healthcare provider’s qualifications and performance. Key sections include:
- Personal Information: Basic details about the healthcare provider, including name, rank, and specialty.
- Professional Qualifications: Information about the provider’s education, training, certifications, and licenses.
- Clinical Competencies: Detailed assessment of the provider’s skills and proficiency in specific therapeutic radiology procedures.
- Performance Evaluation: Supervisor’s evaluation of the provider’s performance, including strengths, areas for improvement, and overall competence.
- Recommendations: Final recommendations regarding the granting or renewal of clinical privileges.
Privacy and Distribution
The form includes a Privacy Act Statement as required by AR 340-21 to ensure the confidentiality of the provider’s personal and professional information. It is produced only in electronic media to facilitate easy distribution and storage. The form is classified as unclassified and is approved for public release, with no distribution restrictions.
Utilizing DA FORM 5441-40
For Healthcare Providers
Healthcare providers specializing in therapeutic radiology must complete DA FORM 5441-40 to obtain or renew their clinical privileges. It is essential to provide accurate and comprehensive information to facilitate a thorough evaluation of their qualifications and competencies.
For Evaluators
Supervisors and evaluating authorities use this form to assess the clinical abilities of healthcare providers. They must ensure that the evaluation is objective, fair, and based on established standards to uphold the quality of care provided within military medical facilities.
Conclusion
DA FORM 5441-40 – Evaluation Of Clinical Privileges – Therapeutic Radiology plays a vital role in maintaining high standards of clinical practice in the field of therapeutic radiology. By ensuring that only qualified and competent providers are granted clinical privileges, the form helps safeguard patient safety and enhance the overall quality of care within the military healthcare system. Proper utilization of this form, in compliance with AR 40-68, is essential for the effective management and evaluation of healthcare professionals.
DA FORM 5441-40 Fillable – Army Pubs 5441-40 PDF DOWNLOAD
