DA Form 5440-38. Delineation of Clinical Privileges - Clinical Pharmacy

DA Form 5440-38 is the Delineation of Clinical Privileges - Clinical Pharmacy form used to establish and document the clinical privileges of clinical pharmacists within the Department of the Army. This form outlines the scope of pharmaceutical assessment and treatment procedures that clinical pharmacists are authorized to perform.

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

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

Application Example: A clinical pharmacist seeks clinical privileges within the Department of the Army. They use DA Form 5440-38 to outline their qualifications, requested clinical pharmacy 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 clinical pharmacists.

DA Form 5440-39 is a related form that serves a similar purpose but is specific to the Delineation of Clinical Privileges - Nuclear Medicine. DA Form 5440-39 is used for nuclear medicine practitioners seeking clinical privileges, outlining the scope of procedures they are authorized to perform.