DA Form 5441-48. Evaluation of Clinical Privileges - Oral & Maxillofacial Surgery

DA Form 5441-48 is utilized for evaluating clinical privileges in the field of Oral & Maxillofacial Surgery. This form plays a crucial role in assessing and establishing the qualifications and requested privileges for medical professionals specializing in surgical procedures involving the mouth, jaws, and facial structures.

The form consists of sections where the oral and maxillofacial surgeon provides personal and professional details, including licenses, certifications, and qualifications specific to their surgical practice. It requires outlining the requested clinical privileges, covering areas such as dental extractions, maxillofacial reconstructions, and facial trauma interventions.

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

Application Example: An oral and maxillofacial surgeon joining a military medical facility would use DA Form 5441-48 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in dental extractions and maxillofacial reconstructions 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, 5441-47, 5441-49, and 5441-5 are related forms intended for different clinical privilege evaluation processes.