DA Form 5440-45. Delineation of Clinical Privileges - Cardiovascular Surgery

DA Form 5440-45 is designed to delineate clinical privileges in the field of Cardiovascular Surgery. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to cardiovascular surgical procedures.

The form comprises sections where the practitioner provides their personal and professional details, including medical licenses, certifications, and qualifications. It also requires a comprehensive outline of the requested clinical privileges, covering a range of cardiovascular surgical interventions.

Important fields in this form include the practitioner's identifying information, requested clinical privileges, and supporting evidence of their expertise in cardiovascular surgery. Accurate completion of this form is critical to ensure that the practitioner is granted privileges that align with their skill level and experience.

Application Example: A board-certified cardiovascular surgeon joining a military medical facility would utilize DA Form 5440-45 to request clinical privileges. By completing the form accurately and providing necessary documentation, the practitioner's proficiency in cardiovascular surgical procedures is evaluated, enabling the medical facility to grant appropriate privileges.

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

Related Form: DA Form 5440-43, 5440-44, 5440-46, and 5440-47 are related forms intended for different medical specialties, each catering to distinct clinical privileges.