DA Form 5440-55. Delineation of Clinical Privileges - Orthopaedics

DA Form 5440-55 is designed to delineate clinical privileges in the field of Orthopaedics. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to surgical and non-surgical management of musculoskeletal conditions and injuries.

The form comprises sections where the practitioner provides personal and professional details, including medical licenses, certifications, and qualifications. It also requires outlining the requested clinical privileges, encompassing various orthopaedic procedures and interventions.

Important fields in this form include the practitioner's identifying information, requested clinical privileges, and supporting documentation showcasing their expertise in orthopaedics. Accurate completion of this form is essential to ensure that the practitioner is granted privileges that align with their skill set in managing musculoskeletal disorders.

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