DA Form 5441-46: Pulmonary Disease Clinical Privileges

DA Form 5441-46: Pulmonary Disease Clinical Privileges – DA Form 5441-46: Evaluation of Clinical Privileges – Pulmonary Disease is a key U.S. Army document used to assess the competency of healthcare providers in pulmonary medicine within military treatment facilities (MTFs).

This form supports the Army’s rigorous credentialing and privileging process under AR 40-68, Clinical Quality Management, ensuring that pulmonologists and related providers demonstrate the skills needed for safe, high-quality patient care.

What Is DA Form 5441-46?

DA Form 5441-46 (February 2004 edition) is titled “Evaluation of Clinical Privileges – Pulmonary Disease.” It pairs with DA Form 5440-46 (Delineation of Clinical Privileges – Pulmonary Disease) for initial granting and ongoing renewal of privileges.

Primary Purpose:
Department/service chiefs use it to evaluate a provider’s demonstrated patient management abilities and technical competence in pulmonary procedures. Evaluators rate each privilege as Acceptable, Unacceptable, or Not Applicable, with explanations required for any “Unacceptable” ratings.

Key Details:

  • For Use With: AR 40-68 (proponent: Office of The Surgeon General – OTSG).
  • Pages: 2.
  • Latest Official Source: Army Publishing Directorate (APD).

Download the Official Form Here:
DA Form 5441-46 PDF

Who Uses This Form?

  • Pulmonary Disease Specialists (physicians, often board-certified in Pulmonary Disease and/or Critical Care Medicine).
  • Military Medical Facilities (Army MTFs, including hospitals and clinics).
  • Credentials Committees for initial appointment, reappointment, and renewal of clinical privileges.
  • Providers transitioning between duty stations or seeking expanded scope of practice.

It aligns with broader DoD and Army standards for clinical quality management, which emphasize ongoing competency assessment, peer review, and patient safety.

Procedures and Skills Evaluated on DA Form 5441-46

The form lists core pulmonary procedures and skills. Evaluators assign an approval code (referencing the corresponding DA Form 5440) and mark performance as Acceptable/Unacceptable/Not Applicable.

Key Categories Include:

  • Airway and Thoracic Procedures: Tube thoracostomy, thoracentesis, paracentesis, pericardiocentesis.
  • Bronchoscopy and Diagnostic Tools: Diagnostic bronchoscopy, interventional bronchoscopy, bronchial brushing, bronchial lavage, bronchograms, diagnostic/interventional laryngoscopy.
  • Biopsies and Aspirations: Transthoracic needle lung aspiration/biopsy, pleural biopsy (closed), transtracheal aspiration, bone marrow aspiration/biopsy.
  • Critical Care and Monitoring: Pulmonary artery catheterization, endotracheal intubation, respirator management, arterial puncture/cannulation, central venous puncture.
  • Testing Interpretation: Pulmonary function testing, cardiopulmonary exercise testing, electrocardiograms, polysomnograms.
  • Advanced Interventions: Percutaneous tracheostomy, bronchoprovocation challenge, whole lung lavage under general anesthesia, laser privileges (e.g., YAG laser ablation via bronchoscopy, photodynamic therapy).
  • Other: Administration of conscious sedation, elective cardioversion, cardiac pacemaker insertion, spinal tap, arthrocentesis.

Laser Privileges appear in a dedicated section.

This comprehensive list ensures providers are evaluated on both routine and high-risk procedures relevant to pulmonary disease management, including respiratory failure, critical care, and procedural interventions.

How the Evaluation Process Works?

  1. Provider Information: Name, rank/grade, evaluation period, department/service, facility.
  2. Section I – Evaluation: Chief rates each procedure/skill.
  3. Section II – Comments: Detailed explanations, especially for unacceptable ratings.
  4. Signature and Date: By the evaluator (typically Department/Service Chief).

Ratings directly influence reappraisal, renewal of privileges, and medical staff appointment. Any “Unacceptable” rating requires documentation and may lead to remediation or privilege restrictions.

Why This Form Matters for Patient Safety and Military Medicine?

Accurate privileging protects Soldiers, families, and beneficiaries by ensuring only competent providers perform specialized pulmonary care. Pulmonary conditions (e.g., asthma, COPD, deployment-related respiratory issues) are common in military populations, making expert evaluation essential.

The process complies with federal standards (e.g., 10 U.S.C. Chapters related to medical quality) and supports seamless care across military and civilian transitions.

  • DA Form 5440-46: For initial delineation of requested privileges.
  • AR 40-68: Full Clinical Quality Management regulation (2004 with 2009 RAR).
  • Army Publishing Directorate forms portal for all DA forms.
  • DoD medical privileging guidance for joint service alignment.

Note: Always use the most current official versions from armypubs.army.mil. Forms and policies can be updated; check for revisions.

For U.S. Army medical professionals, DA Form 5441-46 remains a cornerstone of ensuring clinical excellence in pulmonary disease care. Proper completion and documentation support both individual career progression and the Army Medicine mission of providing ready, responsive healthcare.