DA Form 5441-45. Evaluation of Clinical Privileges - Cardiovascular Surgery

DA Form 5441-45 is intended for evaluating clinical privileges for Cardiovascular Surgery practitioners. This form plays a critical role in assessing and establishing the qualifications and requested privileges for medical professionals specializing in performing surgical procedures on the heart and blood vessels.

The form consists of sections where the cardiovascular surgeon provides personal and professional details, including licenses, certifications, and qualifications specific to cardiovascular surgery practice. It requires outlining the requested clinical privileges, covering areas such as cardiac surgeries, vascular procedures, and postoperative care.

Key fields in this form include the cardiovascular surgeon's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in cardiovascular surgery. Accurate completion of this form is vital to ensure that the practitioner is granted privileges aligned with their proficiency in performing complex cardiovascular surgeries.

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