DA Form 5441-25. Evaluation of Clinical Privileges - General Medical Officer

DA Form 5441-25 serves as a significant tool for evaluating clinical privileges for General Medical Officers (GMOs). This form is crucial for assessing and establishing the qualifications and requested privileges for medical officers involved in providing general medical care across a range of disciplines.

The form includes sections where the medical officer provides personal and professional details, including licenses, certifications, and qualifications specific to general medical practice. It necessitates outlining the requested clinical privileges, covering areas such as patient care, diagnostic evaluations, and treatment planning.

Important fields in this form include the medical officer's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in general medical practice. Accurate completion of this form is paramount to ensure that the medical officer is granted privileges aligned with their proficiency in delivering comprehensive medical care.

Application Example: A medical officer joining a military medical facility in a general practitioner role would utilize DA Form 5441-25 to request clinical privileges. By accurately completing the form and providing necessary documentation, the officer's proficiency in general medical care and diagnostic evaluations 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 5441-21, 5441-22, 5441-23, and 5441-24 are related forms intended for different clinical privilege evaluation processes.