DA Form 5441-53. Evaluation of Clinical Privileges - Occupational Medicine

DA Form 5441-53 serves the purpose of evaluating clinical privileges for Occupational Medicine practitioners. This form is crucial for assessing and establishing the qualifications and requested privileges for medical professionals specializing in workplace-related health and safety.

The form comprises sections where the occupational medicine specialist provides personal and professional details, including licenses, certifications, and qualifications specific to occupational medicine practice. It requires outlining the requested clinical privileges, covering areas such as health assessments, injury management, and workplace health promotion.

Important fields in this form include the specialist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in occupational medicine. Accurate completion of this form is vital to ensure that the practitioner is granted privileges aligned with their proficiency in managing workplace-related health issues.

Application Example: An occupational medicine specialist joining a military medical facility would utilize DA Form 5441-53 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in health assessments and workplace health promotion 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, 5441-52, and 5441-54 are related forms intended for different clinical privilege evaluation processes.