DA Form 5441-6. Evaluation of Clinical Privileges-Optometry

DA Form 5441-6 is used to evaluate clinical privileges for practitioners specializing in Optometry. This form plays a crucial role in assessing and establishing the qualifications and requested privileges for medical professionals engaged in eye care and vision-related services.

The form consists of sections where the optometrist provides personal and professional details, including licenses, certifications, and qualifications specific to optometry practice. It requires outlining the requested clinical privileges, covering areas such as eye examinations, vision correction, and eye health assessments.

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

Application Example: An optometrist joining a military medical facility would use DA Form 5441-6 to request clinical privileges. By accurately completing the form and providing necessary documentation, the practitioner's proficiency in eye examinations and vision correction 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, 5441-57, and 5441-58 are related forms intended for different clinical privilege evaluation processes.