DA Form 5441-42. Evaluation of Clinical Privileges - Cardiology

DA Form 5441-42 is intended for evaluating clinical privileges for Cardiology practitioners. This form serves the crucial purpose of assessing and establishing the qualifications and requested privileges for medical professionals specializing in diagnosing and treating cardiovascular diseases.

The form comprises sections where the cardiologist provides personal and professional details, including licenses, certifications, and qualifications specific to cardiology practice. It requires outlining the requested clinical privileges, covering areas such as cardiac evaluations, diagnostic procedures, and cardiovascular interventions.

Key fields in this form include the cardiologist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in cardiology. Accurate completion of this form is vital to ensure that the practitioner is granted privileges aligned with their proficiency in diagnosing and treating cardiovascular conditions.

Application Example: A board-certified cardiologist joining a military medical facility would utilize DA Form 5441-42 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in cardiac evaluations and interventional 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 5441-41, 5441-43, 5441-44, and 5441-45 are related forms intended for different clinical privilege evaluation processes.