DA Form 5440-9. Delineation of Clinical Privileges-Podiatry

DA Form 5440-9 is a significant document used for delineating clinical privileges in the field of Podiatry. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to the assessment, diagnosis, and treatment of foot and ankle conditions.

The form consists of sections where the practitioner provides personal and professional details, including licenses, certifications, and qualifications specific to podiatric care. It necessitates outlining the requested clinical privileges, covering areas such as podiatric examinations, surgical interventions, and treatment of foot-related disorders.

Important fields in this form include the practitioner's identification information, requested clinical privileges, and supporting documentation that showcases their expertise in podiatric care. Accurate completion of this form is crucial to ensure that the practitioner is granted privileges aligned with their skill set in addressing foot and ankle conditions.

Application Example: A licensed podiatrist joining a military medical facility would utilize DA Form 5440-9 to request clinical privileges. By accurately completing the form and submitting necessary documentation, the podiatrist's proficiency in diagnosing and treating foot-related conditions 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 5440a, 5441, 5441-1, and 5441-10 are related forms intended for different clinical privilege evaluation processes.