DA Form 5441-41. Evaluation of Clinical Privileges - Physical Medicine and Rehabilitation

DA Form 5441-41 is utilized for evaluating clinical privileges in the field of Physical Medicine and Rehabilitation. This form serves the critical purpose of assessing and establishing the qualifications and requested privileges for medical professionals specializing in physical medicine, rehabilitation, and related therapies.

The form consists of sections where the practitioner provides personal and professional details, including licenses, certifications, and qualifications specific to physical medicine and rehabilitation practice. It requires outlining the requested clinical privileges, covering areas such as musculoskeletal assessments, rehabilitation plans, and therapeutic interventions.

Important fields in this form include the practitioner's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in physical medicine and rehabilitation. Accurate completion of this form is crucial to ensure that the practitioner is granted privileges aligned with their proficiency in diagnosing and treating musculoskeletal and functional disorders.

Application Example: A board-certified physiatrist (Physical Medicine and Rehabilitation specialist) joining a military medical facility would use DA Form 5441-41 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in musculoskeletal assessments and rehabilitation planning 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 5441-42, 5441-43, 5441-44, and 5441-45 are related forms intended for different clinical privilege evaluation processes.