DAFORMFILLABLE.COM | DA FORM 5441-43 Fillable – Army Pubs 5441-43 PDF – DA FORM 5441-43, officially titled Evaluation Of Clinical Privileges – Ophthalmology, is a crucial document in the medical field, specifically for evaluating the clinical privileges of ophthalmologists within military settings. This form ensures that ophthalmologists are assessed fairly and accurately based on their skills and competencies.
DA FORM 5441-43 – Evaluation Of Clinical Privileges – Ophthalmology
| Form Number | DA Form 5441-43 |
| Form Title | Evaluation Of Clinical Privileges – Ophthalmology |
| Form Date | 02/01/2004 |
| Form Proponent | TSG |
Purpose and Importance of DA FORM 5441-43
DA FORM 5441-43 is designed to evaluate the clinical privileges of ophthalmologists. The form’s purpose is to ensure that practitioners meet the required standards to provide safe and effective eye care. This evaluation is necessary for maintaining high standards of medical care within the military and ensuring that only qualified professionals are granted the privilege to practice ophthalmology.
Key Features of DA FORM 5441-43
Publication Details
- Pub/Form Number: DA FORM 5441-43
- Pub/Form Date: 02/01/2004
- Pub/Form Title: Evaluation Of Clinical Privileges – Ophthalmology
- Pub/Form Proponent: TSG (The Surgeon General)
- Pub/Form Status: Active
Prescribing Directive and Privacy Act
The form is prescribed by AR 40-68, which provides guidelines on the assessment of clinical privileges. Additionally, the form requires a Privacy Act Statement (AR 340-21), ensuring the confidentiality and protection of personal information provided in the evaluation.
Availability and Security Classification
- Footnotes:
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- Security Classification: Unclassified
- Distribution Restriction Code: A (Approved for public release; distribution is unlimited)
Structure and Content of DA FORM 5441-43
The form is structured to comprehensively evaluate the ophthalmologist’s competencies. It includes sections for:
- Personal Information: Basic details of the ophthalmologist being evaluated.
- Clinical Competence: Detailed assessment of the ophthalmologist’s skills and abilities.
- Professional Experience: Overview of the ophthalmologist’s professional background and experience.
- Evaluator’s Comments: Space for the evaluator to provide additional comments and recommendations.
Using DA FORM 5441-43 Effectively
Submission and Review Process
The DA FORM 5441-43 is typically submitted electronically, following the guidelines provided by the military medical authority. The form is reviewed by designated evaluators who assess the ophthalmologist’s qualifications and competencies against the standards outlined in AR 40-68.
Ensuring Accurate Evaluations
For an effective evaluation, it is essential that the evaluator:
- Thoroughly reviews the ophthalmologist’s professional history and clinical performance.
- Provides detailed feedback in the evaluator’s comments section.
- Ensures compliance with the privacy and security guidelines as per AR 340-21.
Conclusion
DA FORM 5441-43 – Evaluation Of Clinical Privileges – Ophthalmology plays a pivotal role in maintaining high standards of ophthalmic care within military settings. By thoroughly assessing the competencies and qualifications of ophthalmologists, this form helps ensure that only proficient and qualified practitioners are entrusted with the responsibility of providing eye care. Adhering to the prescribed guidelines and maintaining the integrity of the evaluation process is essential for upholding the quality and safety of medical services in the military.
In summary, understanding and effectively utilizing DA FORM 5441-43 is crucial for both evaluators and ophthalmologists. This form not only helps in credentialing but also in enhancing the overall quality of ophthalmic care provided to military personnel.
DA FORM 5441-43 Fillable – Army Pubs 5441-43 PDF DOWNLOAD
