DA Form 5441-49. Evaluation of Clinical Privileges - Plastic Surgery

DA Form 5441-49 serves the purpose of evaluating clinical privileges for Plastic Surgery practitioners. This form plays a crucial role in assessing and establishing the qualifications and requested privileges for medical professionals specializing in surgical procedures involving reconstructive and cosmetic surgery.

The form comprises sections where the plastic surgeon provides personal and professional details, including licenses, certifications, and qualifications specific to plastic surgery practice. It requires outlining the requested clinical privileges, covering areas such as reconstructive surgeries, cosmetic enhancements, and facial aesthetics.

Important fields in this form include the surgeon's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in plastic surgery. Accurate completion of this form is crucial to ensure that the practitioner is granted privileges aligned with their proficiency in performing intricate plastic and reconstructive surgical procedures.

Application Example: A board-certified plastic surgeon joining a military medical facility would utilize DA Form 5441-49 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in reconstructive surgeries and cosmetic enhancements 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, 5441-48, and 5441-5 are related forms intended for different clinical privilege evaluation processes.