DA Form 5441-45: Cardiovascular Surgery Privileges Eval – DA Form 5441-45: Evaluation of Clinical Privileges – Cardiovascular Surgery is a key U.S. Army document used to assess and document a provider’s competence in performing cardiovascular surgical procedures.
This form supports the Army’s Clinical Quality Management Program under AR 40-68, ensuring military healthcare providers meet rigorous standards for patient safety and quality care in military treatment facilities (MTFs).
What Is DA Form 5441-45?
DA Form 5441-45 (dated FEB 2004) is titled Evaluation of Clinical Privileges – Cardiovascular Surgery. It is used by Department/Service Chiefs to evaluate a provider’s performance across specific procedures and skills.
It pairs with DA Form 5440-45 (Delineation of Clinical Privileges – Cardiovascular Surgery), which outlines the requested privileges. The evaluation form rates performance as Acceptable, Unacceptable, or Not Applicable, with mandatory explanations for any “Unacceptable” ratings.
Official Download Link:
DA Form 5441-45 PDF (U.S. Army Publishing Directorate).
Purpose and Context in Army Medicine
Under AR 40-68, clinical privileging ensures providers demonstrate ongoing competence through training, experience, and performance reviews. This process applies to Active Army, Army Reserve, and National Guard medical personnel, as well as civilians working in Army facilities.
Cardiovascular surgery privileges cover pre-operative, intra-operative, and post-operative care for conditions involving the heart, great vessels, conduction system, and related structures. Providers must typically hold board certification or equivalent qualifications in thoracic or cardiothoracic surgery, with documented case volumes and outcomes.
Evaluations occur during initial appointment, reappointment (often every 2-3 years per current MHS policies), and focused reviews. Results directly influence re-privileging and medical staff appointment.
Key Procedures and Skills Evaluated on DA Form 5441-45
The form organizes privileges into categories. Evaluators assign codes from the corresponding DA Form 5440 and rate each as Acceptable/Unacceptable/Not Applicable. Unacceptable ratings require detailed comments.
Minor Procedures
- Subxyphoid window
- Cardioversion
- Insertion of arterial catheters (e.g., Swan-Ganz)
- Intra-aortic balloon pump insertion
Valve Surgery with Cardiopulmonary Bypass (CPB)
- Commissurotomy
- Valve replacement
- Valve repair/reconstruction
- Homograft/autograft replacement
Repair of Congenital Defects (Adults and Children)
- Atrial and ventricular septal defects
- Patent ductus arteriosus
- Sinus venosus
- Bicuspid aortic valve procedures
- Aortic vascular anomalies (coarctation, rings, etc.)
Cardiac Revascularization
- Coronary artery bypass (with CPB, OPCAB, MIDCAB)
- Coronary artery endarterectomy
Conduction System Surgery
- Pacemaker and AICD implantation (transvenous/epicardial)
- Maze procedure
- WPW/accessory pathway division
- Ventricular aneurysmorrhaphy with ablation
Surgery of the Great and Peripheral Vessels
- Aortic replacements (ascending, arch, root, thoracoabdominal)
- Endarterectomy, repair, bypass of innominate, carotid, subclavian, abdominal aortic/iliac, and femoral arteries
Other Categories
- Pulmonary artery surgery (embolectomy, thromboendarterectomy, caval filters)
- Cardiorrhaphy (tumor excision, trauma repair, myocardial rupture/pseudoaneurysm)
- Heart transplant
- Pericardiectomy/pericardial window
- Extracorporeal support (CPB, VADs, ECMO, hypothermic arrest)
- Laser privileges (e.g., transmyocardial revascularization)
The form emphasizes demonstrated patient management abilities and technical competence.
Who Uses This Form?
- Cardiovascular/Thoracic Surgeons in Army hospitals (e.g., Brooke Army Medical Center, Walter Reed)
- Department Chiefs and evaluators
- Credentials Committees
- Providers transitioning between facilities or seeking reappointment
Similar forms exist for related specialties (e.g., DA Form 5441-54 for Thoracic Surgery, vascular surgery privileges).
How to Complete and Use DA Form 5441-45?
- Fill in provider details (Name, Rank, Period of Evaluation, Facility).
- Reference DA Form 5440-45 for privilege codes.
- Rate each procedure/skill.
- Provide comments for any Unacceptable ratings in Section II.
- Evaluator signs and dates.
Completed forms become part of the provider’s credentialing file and inform privileging decisions. Providers must maintain current licensure, board certification (e.g., American Board of Thoracic Surgery), and sufficient procedural volume.
Importance for Patient Safety and Military Readiness
Rigorous privileging protects service members, families, and retirees receiving care in MTFs. It ensures surgeons can handle complex cases like coronary bypass, valve repairs, aortic aneurysms, and trauma—critical for both garrison and deployed settings.
Recent Military Health System updates have streamlined some processes (e.g., longer renewal windows via attestation), but core competency evaluations remain essential.
Related Resources
- AR 40-68: Clinical Quality Management (full regulation)
- DA Form 5440-45: Delineation of Privileges – Cardiovascular Surgery
- Air Force/DOD Master Privilege Lists for Cardiothoracic Surgery (comparable standards)
- Army Medical Command credentialing guidance
Note: Always use the latest official versions from armypubs.army.mil. Forms support but do not replace full credentialing reviews, including peer recommendations, case logs, and outcomes data.
For U.S. Army medical professionals and administrators, mastering DA Form 5441-45 is essential for maintaining high standards in cardiovascular surgical care. Download the form today and consult your local credentials office for facility-specific guidance.