DA Form 5441-2. Evaluation of Clinical Privileges-Family Practice

DA Form 5441-2 serves as a significant document for evaluating clinical privileges within the field of Family Practice. This form is crucial for assessing and establishing the qualifications and requested privileges for medical practitioners involved in providing comprehensive primary healthcare services.

The form includes sections where the practitioner provides personal and professional details, including licenses, certifications, and qualifications specific to family practice. It requires outlining the requested clinical privileges, covering areas such as general medical assessments, preventive care, and treatment of common illnesses.

Important fields in this form include the practitioner's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in family medicine. Accurate completion of this form is paramount to ensure that the practitioner is granted privileges aligned with their proficiency in delivering primary healthcare.

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