DA Form 5440-50. Delineation of Clinical Privileges - Vascular Surgery

DA Form 5440-50 is designed for the delineation of clinical privileges in the field of Vascular Surgery. This form facilitates the documentation and evaluation of a medical practitioner's qualifications and requested privileges related to vascular and circulatory system surgical procedures.

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 a range of vascular surgical interventions.

Important fields in this form include the practitioner's identifying information, requested clinical privileges, and supporting documentation demonstrating their expertise in vascular surgery. Accurate completion of this form is essential to ensure that the practitioner is granted clinical privileges aligned with their skill set.

Application Example: A board-certified vascular surgeon joining a military medical facility would utilize DA Form 5440-50 to request clinical privileges. By accurately completing the form and providing necessary supporting documents, the practitioner's proficiency in vascular surgical procedures is assessed, 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, 5440-5, and 5440-51 are related forms intended for different medical specialties, each tailored for specific clinical privileges.