DA Form 5441-18: Physician Assistant Clinical Privileges

DA Form 5441-18: Physician Assistant Clinical Privileges – DA Form 5441-18: Evaluation of Clinical Privileges – Physician Assistant is a key U.S. Army form used in the credentialing and privileging process for Physician Assistants (PAs) in military medical facilities.

What Is DA Form 5441-18?

DA Form 5441-18, titled “Evaluation of Clinical Privileges – Physician Assistant,” is an official Department of the Army document released in February 2004. It supports AR 40-68 (Clinical Quality Management), with the Office of The Surgeon General (OTSG) as the proponent agency.

This form evaluates a PA’s demonstrated competence in patient management, technical skills, and procedures. It helps determine which clinical privileges a Physician Assistant can exercise in Army healthcare settings, ensuring high standards of patient safety and care quality.

Note: It pairs with DA Form 5440-18 (Delineation of Clinical Privileges – Physician Assistant), where providers initially request specific privileges.

Purpose and Importance in Army Medicine

In the Army Medical Department (AMEDD), clinical privileging verifies that healthcare providers, including PAs, possess the necessary training, experience, and ongoing competence for assigned duties. DA Form 5441-18 plays a critical role by documenting evaluations from department/service chiefs.

Key reasons for its use include:

  • Ensuring Competency: Evaluations cover core and specialty privileges based on actual performance.
  • Patient Safety: Only qualified PAs receive approval for procedures and patient care levels.
  • Compliance: It aligns with Army regulations, DOD policies, and standards for credentialing in federal healthcare.
  • Reappointment and Renewal: Periodic evaluations support reappraisal of privileges and medical staff appointments.

Physician Assistants in the Army (often MOS 65D) work under physician supervision but handle significant autonomy in primary care, procedures, and specialty support.

What Does the Form Evaluate?

The form organizes privileges into categories with checkboxes for Acceptable, Unacceptable, or Not Applicable. Evaluators (typically the Department/Service Chief) rate each area, and any “Unacceptable” ratings require detailed comments.

Category I (Core Clinical Privileges):

  • Diagnose and treat illnesses/injuries across beneficiary categories.
  • Order and interpret lab tests, radiographs (X-ray, CT, MRI, Ultrasound).
  • Prescribe/administer approved medications.
  • Issue temporary profiles (up to 30 days).
  • Perform complete histories and physicals (per AR 40-501).
  • Supervise immunizations.
  • Nuclear and Chemical Surety evaluations.

Category II (Specialty Areas):

  • Aviation Medicine (Aeromedical PA), Orthopedics, Emergency Medicine, Occupational Medicine, Cardiovascular Perfusion, Cardio-thoracic Surgery, Diving/Hyperbaric Medicine, Neurosurgery, Dermatology, and others.

Category III (Procedures):

  • Joint aspiration/injection, wound care/debridement/suturing, incision and drainage, urethral catheterization, IV fluids, nasogastric/nasopharyngeal intubation, fracture stabilization/reduction, and administration of local/digital/intercostal anesthesia.
  • First assist in major surgical cases.

Category IV (Inpatient Privileges):

  • Admission of patients, inpatient H&Ps, doctor’s orders, narrative summaries, and discharge of patients (some requiring physician review).

The form includes sections for provider details (name, rank, evaluation period, facility), evaluator signatures, and comments explaining any concerns.

Who Uses DA Form 5441-18?

  • Army Physician Assistants (military, civilian GS, contractors) seeking or renewing privileges.
  • Department Chiefs and Supervisors conducting evaluations.
  • Credentials Committees at military treatment facilities (MTFs) for final approval decisions.
  • It applies across Army hospitals, clinics, and operational settings.

All PAs generally need NCCPA certification (or successor) for employment and privileging.

How to Complete and Process the Form?

  1. Provider Information: Fill in name, rank/grade, evaluation period, department, and facility.
  2. Evaluation: The chief rates each privilege category.
  3. Codes: Reference corresponding DA Form 5440 series for approval codes.
  4. Comments: Explain any unacceptable ratings in detail.
  5. Signatures and Dates: Evaluator signs and dates; forward to credentials function for review/approval.
  6. Retention: Part of the provider’s credentials file for recredentialing cycles (typically every 2 years).

Download the Official Form:
DA Form 5441-18 PDF (U.S. Army Publications)

  • AR 40-68, Clinical Quality Management (with 2009 Rapid Action Revision) — The governing regulation.
  • Army Medical Department (AMEDD) credentials and privileging guidance.
  • Facility-specific credentialing offices for local procedures.

Why This Matters for Army PAs?

Accurate completion of DA Form 5441-18 directly impacts a PA’s ability to practice fully, support deployments, and advance in their career. It upholds the AMEDD’s commitment to excellence in military healthcare for Soldiers, families, and beneficiaries.

For the most current guidance, consult your local Medical Treatment Facility credentials office or official Army publications, as processes may have service-specific updates while the core form remains foundational.