DA Form 5441-56. Evaluation of Clinical Privileges - Blood Services

DA Form 5441-56 serves the purpose of evaluating clinical privileges for Blood Services practitioners. This form is instrumental in assessing and establishing the qualifications and requested privileges for medical professionals specializing in blood collection, transfusion, and related services.

The form comprises sections where the Blood Services specialist provides personal and professional details, including licenses, certifications, and qualifications specific to blood services practice. It requires outlining the requested clinical privileges, covering areas such as blood donation, transfusion management, and blood component processing.

Important fields in this form include the specialist's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in blood services. Accurate completion of this form is vital to ensure that the practitioner is granted privileges aligned with their proficiency in managing blood collection and transfusion processes.

Application Example: A medical professional specializing in blood services joining a military medical facility would use DA Form 5441-56 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in blood collection and transfusion management 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 5441-55, 5441-57, 5441-58, and 5441-6 are related forms intended for different clinical privilege evaluation processes.