DA Form 5441-4. Evaluation of Clinical Privileges-Neurology

DA Form 5441-4 is utilized for evaluating clinical privileges within the field of Neurology. This form serves the essential purpose of assessing and establishing the qualifications and requested privileges for medical practitioners specializing in diagnosing and treating disorders of the nervous system.

The form includes sections where the neurologist provides personal and professional details, including licenses, certifications, and qualifications specific to neurology practice. It necessitates outlining the requested clinical privileges, encompassing areas such as neurological assessments, diagnostic procedures, and treatment of neurological conditions.

Key fields in this form include the neurologist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in neurology. Accurate completion of this form is crucial to ensure that the practitioner is granted privileges aligned with their proficiency in diagnosing and treating neurological disorders.

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