DA Form 5441. Evaluation of Clinical Privileges - Anesthesia

DA Form 5441 is used for the evaluation of clinical privileges in the field of Anesthesia. This form plays a crucial role in assessing and establishing the qualifications and requested privileges for medical practitioners involved in administering anesthesia and perioperative care.

The form comprises sections where the practitioner provides personal and professional details, including licenses, certifications, and qualifications relevant to anesthesia practice. It necessitates outlining the requested clinical privileges, covering aspects of anesthesia administration and perioperative monitoring.

Important fields in this form include the practitioner's identification details, requested clinical privileges, and supporting documentation showcasing their expertise in anesthesia practice. Accurate completion of this form is paramount to ensure that the practitioner is granted privileges aligned with their skill set and experience in anesthesia care.

Application Example: An anesthesiologist joining a military medical facility would utilize DA Form 5441 to request clinical privileges. By accurately completing the form and providing necessary documentation, the anesthesiologist's proficiency in administering anesthesia and perioperative care 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 5440-9, 5440a, 5441-1, and 5441-10 are related forms intended for different clinical privilege evaluation processes.