DA Form 5440-39. Delineation of Clinical Privileges - Nuclear Medicine

DA Form 5440-39 is the Delineation of Clinical Privileges - Nuclear Medicine form used to establish and document the clinical privileges of nuclear medicine practitioners within the Department of the Army. This form outlines the scope of nuclear medicine assessment and treatment procedures that practitioners are authorized to perform.

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

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

Application Example: A nuclear medicine practitioner seeks clinical privileges within the Department of the Army. They use DA Form 5440-39 to outline their qualifications, requested nuclear medicine 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 nuclear medicine practitioners.