DA Form 5440-52. Delineation of Clinical Privileges - Critical Care Medicine

DA Form 5440-52 serves as a vital tool for delineating clinical privileges specifically within the realm of Critical Care Medicine. This form is indispensable for medical practitioners seeking to establish their qualifications and requested privileges related to the comprehensive management of critically ill patients.

The form consists of sections where the practitioner provides personal information, medical licenses, certifications, and qualifications pertinent to critical care medicine. It necessitates a thorough outline of the requested clinical privileges, covering various aspects of critical care management and interventions.

Important fields in this form include the practitioner's identification details, requested clinical privileges, and supporting documentation showcasing their expertise in critical care medicine. Accurate completion of this form is of utmost importance to ensure that the practitioner is granted privileges aligned with their skill level and experience in managing critically ill patients.

Application Example: An intensivist joining a military medical facility would use DA Form 5440-52 to request clinical privileges. By accurately completing the form and providing necessary supporting documents, the practitioner's proficiency in critical care medicine is evaluated, enabling the medical facility to grant appropriate privileges to manage critically ill patients effectively.

No additional documents are explicitly mentioned as required for filling this form.

Related Form: DA Form 5440-53, 5440-54, 5440-55, and 5440-56 are related forms intended for different medical specialties, each tailored for specific clinical privileges.