DA Form 5440-3 is the Delineation of Clinical Privileges-Internal Medicine form used to establish and document the clinical privileges of internal medicine physicians within the Department of the Army. This form outlines the scope of medical procedures and responsibilities that internal medicine physicians are authorized to perform.
DA Form 5440-29 is the Delineation of Clinical Privileges - Allergy/Immunology form used to establish and document the clinical privileges of allergy/immunology practitioners within the Department of the Army. This form outlines the scope of medical procedures and responsibilities that allergy/immunology practitioners are authorized to perform.
DA Form 5440-28 is the Delineation of Clinical Privileges - Social Work form used to establish and document the clinical privileges of social work practitioners within the Department of the Army. This form outlines the scope of social work procedures and responsibilities that practitioners are authorized to perform.
The form consists of sections where the social work practitioner's information is provided, including their qualifications and requested privileges. It may also include sections for listing specific social work procedures and detailing any restrictions or limitations.
DA Form 5440-25 is the Delineation of Clinical Privileges-General Medical Officer form used to establish and document the clinical privileges of general medical officers within the Department of the Army. This form outlines the scope of medical procedures and responsibilities that general medical officers are authorized to perform.
DA Form 5440-24 is the Delineation of Clinical Privileges-Aerospace Medicine form used to establish and document the clinical privileges of aerospace medicine physicians within the Department of the Army. This form outlines the scope of medical procedures and responsibilities that aerospace medicine physicians are authorized to perform.
DA Form 5440-23 is the Delineation of Clinical Privileges-Emergency Medicine form used to establish and document the clinical privileges of emergency medicine physicians within the Department of the Army. This form outlines the scope of medical procedures and responsibilities that emergency medicine physicians are authorized to perform.
DA Form 5440-22 is the Delineation of Clinical Privileges form used to establish and document the clinical privileges of healthcare practitioners within the Department of the Army for whom specific specialty forms are not available. This form outlines the scope of medical procedures and responsibilities that practitioners are authorized to perform.
DA Form 5440-21 is the Delineation of Clinical Privileges-Physical Therapy form used to establish and document the clinical privileges of physical therapists within the Department of the Army. This form outlines the scope of physical therapy procedures and responsibilities that therapists are authorized to perform.
The form consists of sections where the physical therapist's information is provided, including their qualifications and requested privileges. It may also include sections for listing specific physical therapy procedures and detailing any restrictions or limitations.
DA Form 5440-20 is the Delineation of Clinical Privileges-Occupational Therapy form used to establish and document the clinical privileges of occupational therapists within the Department of the Army. This form outlines the scope of occupational therapy procedures and responsibilities that therapists are authorized to perform.
DA Form 5440-2 is the Delineation of Clinical Privileges-Family Practice form used to establish and document the clinical privileges of family practice physicians within the Department of the Army. This form outlines the scope of medical procedures and responsibilities that family practice physicians are authorized to perform.
