DA Form 5440-13 – Delineation Of Clinical Privileges-General Surgery

FREE-ONLINE-FORMS.COMDA Form 5440-13 – Delineation Of Clinical Privileges-General Surgery – The DA Form 5440-13, also known as the “Delineation of Clinical Privileges-General Surgery,” is a document used in the military medical field, particularly by the United States Army. This form is part of the credentialing process for medical professionals, specifically those specializing in general surgery.

The purpose of the DA Form 5440-13 is to outline and delineate the clinical privileges granted to a medical professional within the field of general surgery. It typically includes specific procedures, treatments, and interventions that the surgeon is authorized to perform based on their training, experience, and qualifications.

Download DA Form 5440-13 – Delineation Of Clinical Privileges-General Surgery

Form Number DA Form 5440-13
Form Title Delineation Of Clinical Privileges-General Surgery
Edition Date 2/1/2004
File Size 54 KB

The form may include sections such as:

  1. Personal Information: Name, rank, credentials, contact information, etc., of the medical professional.
  2. Training and Education: Details about the surgeon’s medical education, residency, fellowships, and other relevant training.
  3. Experience: Summary of the surgeon’s experience in general surgery, including the number of procedures performed and any specific areas of expertise.
  4. Clinical Privileges: A list of specific surgical procedures, treatments, and interventions for which the surgeon is granted clinical privileges. This section may include details such as the scope of practice, limitations, and any additional requirements or conditions.
  5. Attestation: Signature of the medical professional and any supervising authority, indicating agreement to the delineated clinical privileges.

This form plays a crucial role in ensuring that medical professionals are appropriately credentialed and authorized to perform specific medical procedures within their specialty. It helps to maintain standards of care, patient safety, and regulatory compliance within military medical facilities.

DA Form 5440-13 Example

DA Form 5440-13