DA Form 5441-15. Evaluation of Clinical Privileges - Certified Nurse Midwife

DA Form 5441-15 serves as a significant tool for evaluating clinical privileges for Certified Nurse Midwives. This form is essential for assessing and establishing the qualifications and requested privileges for certified nurse midwives involved in providing comprehensive maternity care.

The form comprises sections where the nurse midwife provides personal and professional details, including certifications and qualifications specific to midwifery practice. It necessitates outlining the requested clinical privileges, covering areas such as prenatal care, labor and delivery assistance, and postpartum care.

Key fields in this form include the nurse midwife's identification information, requested clinical privileges, and supporting evidence of their expertise in midwifery care. Accurate completion of this form is crucial to ensure that the nurse midwife is granted privileges aligned with their proficiency in providing maternity care.

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