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DA Form 5754 Malpractice History and Clinical Privileges Questionnaire
What Is DA Form 5754?
This is a military form that was released by the U.S. Department of the Army (DA) on April 1, 2009. The form, often mistakenly referred to as the DD Form 5754, 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 5754?
A: DA Form 5754 is a Malpractice History and Clinical Privileges Questionnaire.
Q: What is the purpose of DA Form 5754?
A: The purpose of DA Form 5754 is to gather information about an individual's malpractice history and clinical privileges.
Q: Who needs to fill out DA Form 5754?
A: DA Form 5754 needs to be filled out by individuals who are applying for clinical privileges.
Q: What information is required on DA Form 5754?
A: DA Form 5754 requires information about previous malpractice claims, disciplinary actions, and clinical privileges.
Form Details:
- A 2-page document available for download in PDF;
- The latest version available from the Army Publishing Directorate;
- Editable, free, and easy to use;
- Fill out the form in our online filing application.
Download an up-to-date fillable DA Form 5754 down below in PDF format or browse hundreds of other DA Forms stored in our online database.
Download DA Form 5754 Malpractice History and Clinical Privileges Questionnaire
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