DA Form 5441-50. Evaluation of Clinical Privileges - Vascular Surgery

DA Form 5441-50 is used for evaluating clinical privileges in the field of Vascular Surgery. This form plays a crucial role in assessing and establishing the qualifications and requested privileges for medical professionals specializing in surgical interventions related to the vascular system.

The form consists of sections where the vascular surgeon provides personal and professional details, including licenses, certifications, and qualifications specific to vascular surgery practice. It requires outlining the requested clinical privileges, covering areas such as vascular interventions, endovascular procedures, and circulatory disorder management.

Key fields in this form include the surgeon's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in vascular surgery. Accurate completion of this form is essential to ensure that the practitioner is granted privileges aligned with their proficiency in diagnosing and treating vascular conditions.

Application Example: A vascular surgeon joining a military medical facility would utilize DA Form 5441-50 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in vascular interventions and endovascular procedures 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 5441-51, 5441-52, 5441-53, and 5441-54 are related forms intended for different clinical privilege evaluation processes.