DA Form 5440-54. Delineation of Clinical Privileges - Thoracic Surgery

DA Form 5440-54 is intended for the delineation of clinical privileges within the field of Thoracic Surgery. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to surgical procedures involving the chest, lungs, and esophagus.

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 a range of thoracic surgical interventions.

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

Application Example: A board-certified thoracic surgeon joining a military medical facility would utilize DA Form 5440-54 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in thoracic 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 5440-52, 5440-53, 5440-55, and 5440-56 are related forms intended for different medical specialties, each tailored for specific clinical privileges.