DA Form 5440-13. Delineation of Clinical Privileges-General Surgery

DA Form 5440-13 is the Delineation of Clinical Privileges-General Surgery form used to establish and document the clinical privileges of general surgery practitioners within the Department of the Army. This form outlines the scope of surgical procedures and responsibilities that practitioners are authorized to perform.

The form consists of sections where the general surgery practitioner's information is provided, including their qualifications and requested privileges. It may also include sections for listing specific surgical procedures and detailing any restrictions or limitations.

Important fields in this form include practitioner qualifications, requested general surgery privileges, and specific surgical procedures authorized. Accurate completion of this form is essential for maintaining proper surgical standards and patient care.

Application Example: A general surgeon seeks clinical privileges within the Department of the Army. They use DA Form 5440-13 to outline their qualifications, requested general surgery privileges, and the range of surgical procedures they are qualified to perform.

No additional documents are typically required to complete this form, as it captures all necessary information related to delineating clinical privileges for general surgery practitioners.

DA Form 5440-1 is a related form that serves a similar purpose but is specific to the Delineation of Clinical Privileges-Dentistry. DA Form 5440-1 is used for dental practitioners seeking clinical privileges, outlining the scope of dental procedures they are authorized to perform.