DA Form 5440-16. Delineation of Clinical Privileges-Nurse Practitioner

DA Form 5440-16 is a related form that serves a similar purpose but is specific to the Delineation of Clinical Privileges-Nurse Practitioner. DA Form 5440-16 is used for nurse practitioners seeking clinical privileges, outlining the scope of medical procedures they are authorized to perform.

DA Form 5440-16 is the Delineation of Clinical Privileges-Nurse Practitioner form used to establish and document the clinical privileges of nurse practitioners within the Department of the Army. This form outlines the scope of medical procedures and responsibilities that nurse practitioners are authorized to perform.

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

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

Application Example: A nurse practitioner seeks clinical privileges within the Department of the Army. They use DA Form 5440-16 to outline their qualifications, requested medical privileges, and the range of medical 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 practitioners.

DA Form 5440-15 is a related form that serves a similar purpose but is specific to the Delineation of Clinical Privileges-Certified Nurse Midwives. DA Form 5440-15 is used for certified nurse midwives seeking clinical privileges, outlining the scope of midwifery procedures they are authorized to perform.