DA Form 5440-47. Delineation of Clinical Privileges - Preventive Medicine

DA Form 5440-47 is designed to delineate clinical privileges in the field of Preventive Medicine. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to preventive health measures and public health interventions.

The form comprises sections where the practitioner provides their personal and professional details, including medical licenses, certifications, and qualifications. It also requires outlining the requested clinical privileges, covering areas such as disease prevention, health education, and community health initiatives.

Important fields in this form include the practitioner's identifying information, requested clinical privileges, and supporting evidence of their expertise in preventive medicine. Accurate completion of this form is crucial to ensure that the practitioner is granted privileges aligned with their preventive health knowledge.

Application Example: A preventive medicine specialist joining a military medical facility would utilize DA Form 5440-47 to request clinical privileges. By completing the form accurately and providing necessary supporting documents, the practitioner's proficiency in preventive medicine is assessed, allowing 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, 5440-45, and 5440-46 are related forms intended for different medical specialties, each catering to distinct clinical privileges.