DA Form 5440-37. Delineation of Clinical Privileges - Speech Pathology

DA Form 5440-37 is the Delineation of Clinical Privileges - Speech Pathology form used to establish and document the clinical privileges of speech pathologists within the Department of the Army. This form outlines the scope of speech and language assessment and treatment procedures that speech pathologists are authorized to perform.

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

Important fields in this form include practitioner qualifications, requested speech pathology privileges, and specific assessment and treatment procedures authorized. Accurate completion of this form is crucial for maintaining proper communication health standards and patient care.

Application Example: A speech pathologist seeks clinical privileges within the Department of the Army. They use DA Form 5440-37 to outline their qualifications, requested speech pathology privileges, and the range of assessment and treatment 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 speech pathologists.

DA Form 5440-38 is a related form that serves a similar purpose but is specific to the Delineation of Clinical Privileges - Clinical Pharmacy. DA Form 5440-38 is used for clinical pharmacists seeking clinical privileges, outlining the scope of pharmaceutical procedures they are authorized to perform.