DA Form 5441-35. Evaluation of Clinical Privileges - Psychological Associate

DA Form 5441-35 is utilized for evaluating clinical privileges for Psychological Associates. This form is essential for assessing and establishing the qualifications and requested privileges for professionals specializing in assisting licensed psychologists and other mental health practitioners in delivering psychological services.

The form includes sections where the psychological associate provides personal and professional details, including licenses, certifications, and qualifications specific to psychological associate practice. It requires outlining the requested clinical privileges, covering areas such as psychological assessments, therapy support, and patient care coordination.

Important fields in this form include the psychological associate's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in assisting mental health practitioners. Accurate completion of this form is vital to ensure that the practitioner is granted privileges aligned with their proficiency in supporting psychological services.

Application Example: A licensed psychological associate joining a military medical facility would utilize DA Form 5441-35 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in assisting mental health practitioners with assessments and patient care coordination 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 5441-32, 5441-33, 5441-34, and 5441-36 are related forms intended for different clinical privilege evaluation processes.