DA Form 5440-25. Delineation of Clinical Privileges-General Medical Officer

DA Form 5440-25 is the Delineation of Clinical Privileges-General Medical Officer form used to establish and document the clinical privileges of general medical officers within the Department of the Army. This form outlines the scope of medical procedures and responsibilities that general medical officers are authorized to perform.

The form consists of sections where the general medical officer'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 general medical officer privileges, and specific medical procedures authorized. Accurate completion of this form is crucial for maintaining proper medical standards and patient care.

Application Example: A general medical officer seeks clinical privileges within the Department of the Army. They use DA Form 5440-25 to outline their qualifications, requested general medical officer 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 general medical officers.

DA Form 5440-22 is a related form that serves a similar purpose but is a more general form used for healthcare practitioners for whom specialty-specific forms are not available.