DA Form 5441-13. Evaluation of Clinical Privileges - General Surgery

DA Form 5441-13 is designed for the evaluation of clinical privileges within the field of General Surgery. This form serves as a formal request for medical practitioners to establish their qualifications and requested privileges related to a broad range of surgical procedures and interventions.

The form comprises sections where the practitioner provides personal and professional details, including licenses, certifications, and qualifications specific to general surgery. It requires outlining the requested clinical privileges, covering areas such as preoperative evaluation, surgical procedures, and postoperative care.

Important fields in this form include the practitioner's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in general surgery. Accurate completion of this form is essential to ensure that the practitioner is granted privileges aligned with their skill set in performing surgical procedures.

Application Example: A board-certified general surgeon joining a military medical facility would utilize DA Form 5441-13 to request clinical privileges. By accurately completing the form and providing necessary documentation, the surgeon's proficiency in various surgical interventions 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 5441-11, 5441-12, 5441-14, and 5441-15 are related forms intended for different clinical privilege evaluation processes.