DA Form 5441-28. Evaluation of Clinical Privileges - Social Work

DA Form 5441-28 is utilized for evaluating clinical privileges in the field of Social Work. This form plays a crucial role in assessing and establishing the qualifications and requested privileges for licensed social workers involved in providing therapeutic and supportive services to patients.

The form comprises sections where the social worker provides personal and professional details, including licenses, certifications, and qualifications specific to social work practice. It necessitates outlining the requested clinical privileges, covering areas such as individual and group therapy, patient assessments, and mental health interventions.

Key fields in this form include the social worker's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in social work practice. Accurate completion of this form is vital to ensure that the social worker is granted privileges aligned with their proficiency in delivering therapeutic interventions and mental health support.

Application Example: A licensed clinical social worker joining a military medical facility would utilize DA Form 5441-28 to request clinical privileges. By accurately completing the form and providing necessary documentation, the social worker's proficiency in individual and group therapy 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 5441-29, 5441-3, 5441-30, and 5441-31 are related forms intended for different clinical privilege evaluation processes.