DA Form 5441-23. Evaluation of Clinical Privileges - Emergency Medicine

DA Form 5441-23 is intended for evaluating clinical privileges within the field of Emergency Medicine. This form is vital for assessing and establishing the qualifications and requested privileges for medical practitioners involved in providing urgent and emergent medical care.

The form comprises sections where the practitioner provides personal and professional details, including licenses, certifications, and qualifications specific to emergency medicine practice. It necessitates outlining the requested clinical privileges, covering areas such as trauma care, critical interventions, and emergency procedures.

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

Application Example: An emergency medicine physician joining a military medical facility would utilize DA Form 5441-23 to request clinical privileges. By accurately completing the form and providing necessary documentation, the physician's proficiency in trauma care and emergent 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 5441-21, 5441-22, 5441-24, and 5441-25 are related forms intended for different clinical privilege evaluation processes.