DA Form 5440-28. Delineation of Clinical Privileges - Social Work

DA Form 5440-28 is the Delineation of Clinical Privileges - Social Work form used to establish and document the clinical privileges of social work practitioners within the Department of the Army. This form outlines the scope of social work procedures and responsibilities that practitioners are authorized to perform.

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

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

Application Example: A social work practitioner seeks clinical privileges within the Department of the Army. They use DA Form 5440-28 to outline their qualifications, requested social work privileges, and the range of 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 social work practitioners.

DA Form 5440-29 is a related form that serves a similar purpose but is specific to the Delineation of Clinical Privileges - Allergy/Immunology. DA Form 5440-29 is used for allergy/immunology practitioners seeking clinical privileges, outlining the scope of procedures they are authorized to perform.