DA Form 5441-24. Evaluation of Clinical Privileges - Aerospace Medicine

DA Form 5441-24 is used for evaluating clinical privileges in the field of Aerospace Medicine. This form is crucial for assessing and establishing the qualifications and requested privileges for medical practitioners involved in providing healthcare services specific to aviation and aerospace environments.

The form includes sections where the practitioner provides personal and professional details, including licenses, certifications, and qualifications specific to aerospace medicine practice. It requires outlining the requested clinical privileges, covering areas such as aviation medical examinations, aerospace-related healthcare, and flight safety evaluations.

Important fields in this form include the practitioner's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in aerospace medicine. Accurate completion of this form is essential to ensure that the practitioner is granted privileges aligned with their proficiency in delivering medical care in aviation and aerospace contexts.

Application Example: An aviation medical examiner joining a military medical facility would utilize DA Form 5441-24 to request clinical privileges. By accurately completing the form and providing necessary documentation, the examiner's proficiency in aviation medical examinations and aerospace-related healthcare 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, 5441-23, and 5441-25 are related forms intended for different clinical privilege evaluation processes.