DA Form 5440-42. Delineation of Clinical Privileges - Cardiology

DA Form 5440-42 is the Delineation of Clinical Privileges - Cardiology form used to establish and document the clinical privileges of cardiologists within the Department of the Army. This form outlines the scope of assessment and treatment procedures that cardiologists are authorized to perform.

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

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

Application Example: A cardiologist seeks clinical privileges within the Department of the Army. They use DA Form 5440-42 to outline their qualifications, requested cardiology 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 cardiologists.