DA Form 5441-10. Evaluation of Clinical Privileges-Psychiatry

DA Form 5441-10 is used for evaluating clinical privileges within the field of Psychiatry. This form plays a significant role in assessing and establishing the qualifications and requested privileges for medical practitioners involved in diagnosing and treating mental health disorders.

The form comprises sections where the psychiatrist provides personal and professional details, including licenses, certifications, and qualifications relevant to psychiatric practice. It necessitates outlining the requested clinical privileges, covering areas such as psychiatric assessments, psychotherapy, and medication management.

Important fields in this form include the psychiatrist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in psychiatric care. Accurate completion of this form is crucial to ensure that the psychiatrist is granted privileges aligned with their skill set and experience in mental health assessments and treatment.

Application Example: A board-certified psychiatrist joining a military medical facility would utilize DA Form 5441-10 to request clinical privileges. By accurately completing the form and providing necessary documentation, the psychiatrist's proficiency in diagnosing and treating mental health disorders 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, and 5441-1 are related forms intended for different clinical privilege evaluation processes.