DA Form 5440-57. Delineation of Clinical Privileges - Psychiatric Advanced Practice Nurse

DA Form 5440-57 is a critical document used for delineating clinical privileges for Psychiatric Advanced Practice Nurses. This form plays a pivotal role in assessing and establishing the qualifications and requested privileges for psychiatric advanced practice nurses involved in providing mental health care services.

The form comprises sections where the nurse provides personal and professional details, including licenses, certifications, and qualifications relevant to psychiatric nursing. It necessitates outlining the requested clinical privileges, which encompass a spectrum of mental health assessments, diagnoses, and treatment interventions.

Key fields in this form include the nurse's identification information, requested clinical privileges, and supporting evidence of their expertise in psychiatric nursing. Accurate completion of this form is of paramount importance as it ensures that the nurse is granted privileges that align with their skill set and experience in mental health care.

Application Example: A certified psychiatric advanced practice nurse seeking employment at a military medical facility would complete DA Form 5440-57. By accurately filling out the form and providing necessary documentation, the nurse's proficiency in psychiatric care is evaluated, enabling the medical facility to grant appropriate clinical privileges for mental health assessments and treatments.

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

Related Form: DA Form 5440-58, 5440-6, 5440-7, and 5440-8 are related forms intended for different medical specialties, each catering to specific clinical privileges.