DA Form 5441-57. Evaluation of Clinical Privileges - Psychiatric Advanced Practice Nurse

DA Form 5441-57 is used for evaluating clinical privileges of Psychiatric Advanced Practice Nurses. This form plays a significant role in assessing and establishing the qualifications and requested privileges for advanced practice nurses specializing in psychiatric and mental health care.

The form consists of sections where the psychiatric advanced practice nurse provides personal and professional details, including licenses, certifications, and qualifications specific to psychiatric nursing practice. It requires outlining the requested clinical privileges, covering areas such as mental health assessments, psychotherapy, and medication management.

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

Application Example: A psychiatric advanced practice nurse joining a military medical facility would use DA Form 5441-57 to request clinical privileges. By accurately completing the form and providing necessary documentation, the nurse's proficiency in mental health assessments and psychotherapy 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, 5441-56, 5441-58, and 5441-6 are related forms intended for different clinical privilege evaluation processes.