DA Form 5441-31: Evaluation of Chiropractic Clinical Privileges

DA Form 5441-31: Evaluation of Chiropractic Clinical Privileges – If you are a chiropractor serving in the U.S. Army, a military healthcare administrator, or a provider seeking clinical privileges in the Military Health System (MHS), DA Form 5441-31 is a critical document. This form standardizes the evaluation of chiropractic clinical privileges under Army Regulation (AR) 40-68, Clinical Quality Management.

What Is DA Form 5441-31?

DA Form 5441-31 (February 2004 edition) is titled “Evaluation of Clinical Privileges – Chiropractic.” It is used by the U.S. Army to assess a chiropractor’s competence in providing patient care within military treatment facilities (MTFs).

The form works alongside DA Form 5440-31 (Delineation of Clinical Privileges – Chiropractic), which outlines the specific privileges requested. The evaluation focuses on demonstrated patient management abilities, technical skills, and procedures appropriate for chiropractic practice in a military setting.

Key Details:

  • Proponent Agency: Office of The Surgeon General (OTSG)
  • Prescribed by: AR 40-68
  • Purpose: Ensure safe, high-quality chiropractic care for active-duty service members and eligible DoD beneficiaries
  • Official Download: DA Form 5441-31 PDF

Who Uses DA Form 5441-31?

  • Army chiropractors (civilian, contract, or active-duty affiliated providers)
  • Department/Service Chiefs at military medical facilities
  • Credentials committees and medical staff responsible for privileging
  • Providers undergoing initial appointment, reappointment, or renewal of privileges

Chiropractic care in the MHS is available primarily to active-duty service members (including activated Guard and Reserve) at designated MTFs. It focuses on non-pharmacologic management of neuromusculoskeletal conditions, supporting readiness and reducing reliance on opioids.

What Privileges Does the Form Evaluate?

Section I of the form requires the Department/Service Chief to rate each privilege category as Acceptable, Unacceptable, or Not Applicable. Evaluators enter a privilege approval code from the corresponding DA Form 5440.

Core Privileges Typically Evaluated Include:

  • Providing chiropractic health care and services as taught in a Council on Chiropractic Education (CCE)-accredited program to eligible active-duty DoD beneficiaries.
  • Performing routine manual and mechanical (osseous and soft tissue) chiropractic procedures for axial and non-axial neuromusculoskeletal disorders.
  • Conducting psychosocial and biophysical patient history and chiropractic physical examinations (excluding vaginal exams), including postural and spinal analysis.
  • Ordering standard diagnostic imaging (e.g., spine series, skull, chest, ribs, pelvis) and laboratory tests (e.g., CBC, electrolytes, urinalysis).
  • Utilizing therapeutic modalities such as heat, cold, ultrasound, hydrotherapy, and electrical stimulation.
  • Recommending temporary limited duty profiles (IAW AR 40-501) and assigning quarters for up to 72 hours (IAW AR 40-66).
  • Ordering orthotic devices available through the MTF.
  • Providing patient education on hygiene, nutrition, exercise, lifestyle changes, stress reduction, and ergonomics.

Any “Unacceptable” rating must be explained in Section II – Comments, including the evaluator’s name, title, signature, and date.

Why Clinical Privileging Matters in the U.S. Army?

Clinical privileging ensures providers practice within their training, experience, and demonstrated competence. In the military context, it directly supports:

  • Force readiness by addressing musculoskeletal injuries (a leading cause of lost duty days).
  • Patient safety through standardized evaluation.
  • Quality management per AR 40-68 and DoD policies.

Chiropractors in the MHS are independent licensed practitioners who typically receive referrals for spine-related and headache complaints.

How to Complete and Use DA Form 5441-31?

  1. Provider Information — Fill in name, rank/grade, evaluation period, department/service, and facility.
  2. Evaluation — The Department/Service Chief reviews performance and rates each privilege.
  3. Codes — Reference DA Form 5440-31 for approval codes.
  4. Comments — Document any deficiencies or justifications.
  5. Signature — Evaluator signs and dates.

The form becomes part of the provider’s credentials file and informs reappraisal/renewal decisions.

Pro Tip: Always use the latest official version from Army Publishing Directorate (armypubs.army.mil) for compliance.

  • AR 40-68 Clinical Quality Management — Governing regulation for all Army privileging.
  • TRICARE Chiropractic Information — Details on the active-duty Chiropractic Health Care Program.
  • DA Form 5440-31 — Companion delineation form.
  • DoD and DHA policies on ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE).

Download DA Form 5441-31

Official PDF: https://armypubs.army.mil/pub/eforms/DR_a/pdf/A5441_31.pdf

For fillable versions or templates, check trusted military forms repositories, but always verify against the official source for current use.

Note: This article provides general information based on publicly available U.S. Army publications. For official guidance, consult your facility’s credentials office, legal advisor, or the current edition of AR 40-68. Policies can evolve, so confirm with authoritative military channels.