DA Form 5441-16. Evaluation of Clinical Privileges - Nurse Practitioner

DA Form 5441-16 is designed for the evaluation of clinical privileges for Nurse Practitioners. This form is a crucial tool for assessing and establishing the qualifications and requested privileges for certified nurse practitioners involved in providing comprehensive healthcare services.

The form comprises sections where the nurse practitioner provides personal and professional details, including certifications and qualifications specific to advanced nursing practice. It necessitates outlining the requested clinical privileges, covering areas such as patient assessments, diagnosis, treatment, and follow-up care.

Key fields in this form include the nurse practitioner's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in advanced nursing care. Accurate completion of this form is of utmost importance as it ensures that the nurse practitioner is granted privileges aligned with their proficiency in delivering healthcare services.

Application Example: A certified nurse practitioner joining a military medical facility would use DA Form 5441-16 to request clinical privileges. By accurately completing the form and providing necessary documentation, the nurse practitioner's proficiency in patient care and treatment 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 5441-18, 5441-19, 5441-2, and 5441-20 are related forms intended for different clinical privilege evaluation processes.