DA Form 5441-1. Evaluation of Clinical Privileges-Dentistry

DA Form 5441-1 serves as a vital tool for evaluating clinical privileges within the field of Dentistry. This form is essential for assessing and establishing the qualifications and requested privileges for dental practitioners involved in a range of dental procedures and treatments.

The form includes sections where the dentist provides personal and professional details, including licenses, certifications, and qualifications specific to dental practice. It requires outlining the requested clinical privileges, covering areas such as dental examinations, restorative procedures, and oral surgery.

Important fields in this form include the dentist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in dental care. Accurate completion of this form is of utmost importance to ensure that the dentist is granted privileges aligned with their skill set and experience in various dental procedures.

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