DA Form 5440-44. Delineation of Clinical Privileges - Otolaryngology

DA Form 5440-44 is designed for the delineation of clinical privileges within the field of Otolaryngology. This form facilitates the documentation and evaluation of a medical practitioner's qualifications, experience, and requested privileges related to ear, nose, and throat (ENT) medical care.

The form consists of sections where the practitioner provides their personal information, medical licenses, and certifications. It also requires the practitioner to outline their requested clinical privileges, including diagnostic procedures, surgical interventions, and other relevant medical services within the ENT specialty.

Important fields in this form include the practitioner's identification details, proposed clinical privileges, and supporting documentation for their expertise in otolaryngology. Accurate completion of this form is vital to ensure that the practitioner is granted appropriate clinical privileges aligned with their qualifications.

Application Example: An ENT specialist joining a military medical facility would utilize DA Form 5440-44 to request clinical privileges. By accurately completing the form and providing supporting documents, the practitioner's qualifications and expertise in otolaryngology are assessed, enabling the medical facility to grant privileges that match their skill set.

No additional documents are explicitly mentioned as required for filling this form.

Related Form: DA Form 5440-43 and other related forms like 5440-45, 5440-46, 5440-47 are counterparts tailored for different medical specialties, each focusing on specific clinical privileges.