DA Form 5441-52. Evaluation of Clinical Privileges - Critical Care Medicine

DA Form 5441-52 is utilized for evaluating clinical privileges in the field of Critical Care Medicine. This form plays a vital role in assessing and establishing the qualifications and requested privileges for medical professionals specializing in critical care interventions for acutely ill patients.

The form consists of sections where the critical care specialist provides personal and professional details, including licenses, certifications, and qualifications specific to critical care medicine practice. It requires outlining the requested clinical privileges, covering areas such as intensive care management, life support procedures, and organ system support.

Key fields in this form include the specialist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in critical care medicine. Accurate completion of this form is essential to ensure that the practitioner is granted privileges aligned with their proficiency in managing critically ill patients.

Application Example: A critical care specialist joining a military medical facility would use DA Form 5441-52 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in intensive care management and life support 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 5441-50, 5441-51, 5441-53, and 5441-54 are related forms intended for different clinical privilege evaluation processes.