DA Form 5440-48. Delineation of Clinical Privileges - Oral & Maxillofacial Surgery

DA Form 5440-48 serves as a tool for delineating clinical privileges specifically within the domain of Oral & Maxillofacial Surgery. This form is essential for medical practitioners seeking to establish their qualifications and requested privileges related to surgical and dental procedures involving the mouth, jaws, and facial structures.

The form consists of sections where the practitioner provides personal information, medical licenses, certifications, and qualifications relevant to oral and maxillofacial surgery. It requires a comprehensive outline of the requested clinical privileges, encompassing a range of surgical interventions and dental procedures within the specialty.

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

Application Example: An oral and maxillofacial surgeon joining a military medical facility would use DA Form 5440-48 to request clinical privileges. By accurately completing the form and providing supporting documentation, the practitioner's proficiency in surgical and dental procedures involving the facial region 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 5440-49, 5440-5, 5440-50, and 5440-51 are related forms intended for different medical specialties, each catering to distinct clinical privileges.