DA Form 5441-5. Evaluation of Clinical Privileges-Obstetrics and Gynecology

DA Form 5441-5 is used to evaluate clinical privileges for practitioners specializing in Obstetrics and Gynecology. This form serves a critical role in assessing and establishing the qualifications and requested privileges for medical professionals specializing in women's reproductive health and childbirth.

The form consists of sections where the obstetrician and gynecologist provides personal and professional details, including licenses, certifications, and qualifications specific to their practice. It requires outlining the requested clinical privileges, covering areas such as prenatal care, gynecological surgeries, and childbirth management.

Key fields in this form include the practitioner's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in obstetrics and gynecology. Accurate completion of this form is vital to ensure that the practitioner is granted privileges aligned with their proficiency in women's reproductive health and maternity care.

Application Example: An obstetrician and gynecologist joining a military medical facility would use DA Form 5441-5 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in prenatal care and gynecological 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 5441-46, 5441-47, 5441-48, and 5441-49 are related forms intended for different clinical privilege evaluation processes.