DA Form 5441-47. Evaluation of Clinical Privileges - Preventive Medicine

DA Form 5441-47 serves the purpose of evaluating clinical privileges for Preventive Medicine practitioners. This form is essential for assessing and establishing the qualifications and requested privileges for medical professionals specializing in promoting health and preventing diseases.

The form comprises sections where the preventive medicine specialist provides personal and professional details, including licenses, certifications, and qualifications specific to preventive medicine practice. It requires outlining the requested clinical privileges, covering areas such as health assessments, disease prevention strategies, and population health management.

Important fields in this form include the preventive medicine specialist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in preventive healthcare. Accurate completion of this form is vital to ensure that the practitioner is granted privileges aligned with their proficiency in promoting health and disease prevention.

Application Example: A preventive medicine specialist joining a military medical facility would utilize DA Form 5441-47 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in health assessments and disease prevention strategies 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 5441-46, 5441-48, 5441-49, and 5441-5 are related forms intended for different clinical privilege evaluation processes.