DA Form 5441-43. Evaluation of Clinical Privileges - Ophthalmology

DA Form 5441-43 is utilized for evaluating clinical privileges in the field of Ophthalmology. This form plays a critical role in assessing and establishing the qualifications and requested privileges for medical professionals specializing in diagnosing and treating eye and vision disorders.

The form consists of sections where the ophthalmologist provides personal and professional details, including licenses, certifications, and qualifications specific to ophthalmology practice. It requires outlining the requested clinical privileges, covering areas such as eye examinations, surgical procedures, and medical management of eye conditions.

Important fields in this form include the ophthalmologist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in ophthalmology. Accurate completion of this form is crucial to ensure that the practitioner is granted privileges aligned with their proficiency in diagnosing and treating eye-related disorders.

Application Example: An ophthalmologist joining a military medical facility would use DA Form 5441-43 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in eye examinations and surgical 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 5441-41, 5441-42, 5441-44, and 5441-45 are related forms intended for different clinical privilege evaluation processes.