DA Form 5440-14. Delineation of Clinical Privileges-Nurse Anesthetists

DA Form 5440-14 is the Delineation of Clinical Privileges-Nurse Anesthetists form used to establish and document the clinical privileges of nurse anesthetists within the Department of the Army. This form outlines the scope of anesthesia procedures and responsibilities that nurse anesthetists are authorized to perform.

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

Important fields in this form include practitioner qualifications, requested nurse anesthetist privileges, and specific anesthesia procedures authorized. Accurate completion of this form is vital for maintaining proper anesthesia standards and patient care.

Application Example: A nurse anesthetist seeks clinical privileges within the Department of the Army. They use DA Form 5440-14 to outline their qualifications, requested anesthesia privileges, and the range of anesthesia 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 nurse anesthetists.

DA Form 5440-10 is a related form that serves a similar purpose but is specific to the Delineation of Clinical Privileges-Psychiatry. DA Form 5440-10 is used for psychiatric practitioners seeking clinical privileges, outlining the scope of psychiatric procedures they are authorized to perform.