DA Form 5440-5. Delineation of Clinical Privileges-Obstetrics and Gynecology

DA Form 5440-5 is intended for the delineation of clinical privileges within the field of Obstetrics and Gynecology. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to women's reproductive health, pregnancy, and childbirth care.

The form includes sections where the practitioner provides personal and professional details, including medical licenses, certifications, and qualifications. It requires outlining the requested clinical privileges, covering areas such as prenatal care, labor and delivery, and gynecological procedures.

Important fields in this form include the practitioner's identification information, requested clinical privileges, and supporting evidence of their expertise in obstetrics and gynecology. Accurate completion of this form is vital to ensure that the practitioner is granted privileges that align with their proficiency in women's health care.

Application Example: A certified obstetrician-gynecologist joining a military medical facility would utilize DA Form 5440-5 to request clinical privileges. By accurately completing the form and submitting necessary documentation, the practitioner's proficiency in women's reproductive health care 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 5440-48, 5440-49, 5440-50, and 5440-51 are related forms intended for different medical specialties, each catering to specific clinical privileges.