DA Form 5440-53 Delineation of Clinical Privileges - Occupational Medicine

What Is DA Form 5440-53?

This is a military form that was released by the U.S. Department of the Army (DA) on February 1, 2004. The form, often mistakenly referred to as the DD Form 5440-53, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

FAQ

Q: What is DA Form 5440-53?
A: DA Form 5440-53 is a form used for delineation of clinical privileges in Occupational Medicine.

Q: What is the purpose of DA Form 5440-53?
A: The purpose of DA Form 5440-53 is to establish and document the clinical privileges of medical personnel in the field of Occupational Medicine.

Q: Who uses DA Form 5440-53?
A: Medical personnel in the field of Occupational Medicine use DA Form 5440-53.

Q: What information does DA Form 5440-53 include?
A: DA Form 5440-53 includes information such as the individual's name, qualifications, scope of practice, and specific clinical privileges granted.

Q: How is DA Form 5440-53 filled out?
A: DA Form 5440-53 is filled out by the individual seeking clinical privileges in Occupational Medicine, with guidance from their supervising authority.

Q: Is DA Form 5440-53 specific to the United States or Canada?
A: DA Form 5440-53 is specific to the United States.

Q: Are there any specific requirements for clinical privileges in Occupational Medicine?
A: Specific requirements for clinical privileges in Occupational Medicine may vary depending on the organization or facility.

Q: Can clinical privileges be modified or revoked?
A: Yes, clinical privileges can be modified or revoked based on changes in qualifications or performance.