DA Form 5441-54. Evaluation of Clinical Privileges - Thoracic Surgery

DA Form 5441-54 is used to evaluate clinical privileges for Thoracic Surgery practitioners. 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 chest and thoracic cavity.

The form consists of sections where the thoracic surgeon provides personal and professional details, including licenses, certifications, and qualifications specific to thoracic surgery practice. It requires outlining the requested clinical privileges, covering areas such as lung surgeries, chest wall procedures, and thoracic trauma interventions.

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

Application Example: A thoracic surgeon joining a military medical facility would use DA Form 5441-54 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in lung surgeries and chest wall 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, 5441-52, and 5441-53 are related forms intended for different clinical privilege evaluation processes.