DA Form 5440-51. Delineation of Clinical Privileges - Neurosurgery

DA Form 5440-51 is intended for the delineation of clinical privileges in the field of Neurosurgery. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to surgical procedures involving the nervous system.

The form includes sections where the practitioner provides personal and professional details, including medical licenses, certifications, and qualifications. It requires detailing the requested clinical privileges, covering areas such as brain and spinal surgery.

Important fields in this form include the practitioner's identification information, requested clinical privileges, and supporting evidence of their expertise in neurosurgery. Accurate completion of this form is crucial to ensure that the practitioner is granted privileges aligned with their proficiency in nervous system surgical procedures.

Application Example: A certified neurosurgeon joining a military medical facility would utilize DA Form 5440-51 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in surgical procedures involving the nervous system 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, 5440-5, and 5440-50 are related forms intended for different medical specialties, each catering to specific clinical privileges.