DA Form 5441-37. Evaluation of Clinical Privileges - Speech Pathology

DA Form 5441-37 is utilized for evaluating clinical privileges within the field of Speech Pathology. This form plays a critical role in assessing and establishing the qualifications and requested privileges for professionals specializing in diagnosing and treating communication and swallowing disorders.

The form includes sections where the speech pathologist provides personal and professional details, including licenses, certifications, and qualifications specific to speech pathology practice. It necessitates outlining the requested clinical privileges, encompassing areas such as speech assessments, swallowing evaluations, and therapeutic interventions.

Key fields in this form include the speech pathologist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in speech pathology. Accurate completion of this form is vital to ensure that the practitioner is granted privileges aligned with their proficiency in diagnosing and treating communication and swallowing disorders.

Application Example: A licensed speech pathologist joining a military medical facility would utilize DA Form 5441-37 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in speech assessments and therapeutic 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 5441-38, 5441-39, 5441-4, and 5441-40 are related forms intended for different clinical privilege evaluation processes.