DA Form 5441-20. Evaluation of Clinical Privileges - Occupational Therapy

DA Form 5441-20 is used for the evaluation of clinical privileges in the field of Occupational Therapy. This form plays a crucial role in assessing and establishing the qualifications and requested privileges for licensed occupational therapists involved in providing therapeutic interventions and services.

The form comprises sections where the occupational therapist provides personal and professional details, including licenses, certifications, and qualifications specific to occupational therapy practice. It necessitates outlining the requested clinical privileges, covering areas such as therapeutic assessments, intervention planning, and patient rehabilitation.

Important fields in this form include the occupational therapist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in occupational therapy. Accurate completion of this form is essential to ensure that the occupational therapist is granted privileges aligned with their proficiency in providing therapeutic interventions.

Application Example: A licensed occupational therapist joining a military medical facility would utilize DA Form 5441-20 to request clinical privileges. By accurately completing the form and providing necessary documentation, the therapist's proficiency in therapeutic assessments and intervention planning is evaluated, enabling the medical facility to grant appropriate privileges.

No additional documents are explicitly mentioned as required for filling this form.

Related Form: DA Form 5441-16, 5441-18, 5441-19, and 5441-2 are related forms intended for different clinical privilege evaluation processes.