DA Form 5440-7. Delineation of Clinical Privileges-Pathology

DA Form 5440-7 is intended for the delineation of clinical privileges within the field of Pathology. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to diagnosing diseases and conditions through laboratory analysis of tissues and specimens.

The form includes sections where the practitioner provides personal and professional details, including licenses, certifications, and qualifications. It requires outlining the requested clinical privileges, covering areas such as anatomical pathology, clinical pathology, and laboratory medicine.

Important fields in this form include the practitioner's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in pathology. Accurate completion of this form is crucial to ensure that the practitioner is granted privileges aligned with their proficiency in pathological diagnosis and laboratory analysis.

Application Example: A board-certified pathologist joining a military medical facility would utilize DA Form 5440-7 to request clinical privileges. By accurately completing the form and providing necessary documentation, the pathologist's proficiency in diagnosing diseases through tissue analysis 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 5440-57, 5440-58, 5440-6, and 5440-8 are related forms intended for different medical specialties, each tailored for specific clinical privileges.