DA Form 5441-32. Evaluation of Clinical Privileges - Dermatology

DA Form 5441-32 is designed for the evaluation of clinical privileges within the field of Dermatology. This form serves the essential purpose of assessing and establishing the qualifications and requested privileges for medical practitioners specializing in diagnosing and treating skin-related conditions and disorders.

The form comprises sections where the dermatologist provides personal and professional details, including licenses, certifications, and qualifications specific to dermatology practice. It requires outlining the requested clinical privileges, encompassing areas such as skin assessments, diagnosis, treatment planning, and dermatologic procedures.

Key fields in this form include the dermatologist's identification information, requested clinical privileges, and supporting documentation demonstrating their expertise in dermatology. Accurate completion of this form is paramount to ensure that the practitioner is granted privileges aligned with their proficiency in diagnosing and treating skin-related conditions.

Application Example: A board-certified dermatologist joining a military medical facility would utilize DA Form 5441-32 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in skin assessments and dermatologic procedures 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 5441-33, 5441-34, 5441-35, and 5441-36 are related forms intended for different clinical privilege evaluation processes.