DA Form 5441-47: Preventive Medicine Privileges Evaluation – DA Form 5441-47: Evaluation of Clinical Privileges – Preventive Medicine is a key U.S. Army document used in the credentialing and privileging process for physicians and providers specializing in preventive medicine.
This form supports the Army Medical Department’s Clinical Quality Management Program under AR 40-68, ensuring providers demonstrate competence in public health, disease prevention, epidemiology, and force health protection.
What Is DA Form 5441-47?
DA Form 5441-47 (February 2004 edition) is the official “Evaluation of Clinical Privileges – Preventive Medicine” form. It evaluates a provider’s performance and competence in specific privilege categories for reappraisal, renewal, or ongoing medical staff appointment.
It pairs with DA Form 5440-47 (Delineation of Clinical Privileges – Preventive Medicine), where providers initially request privileges. The 5441-47 then documents the department/service chief’s evaluation of actual performance.
Download the official form here: DA Form 5441-47 PDF.
Purpose and Key Instructions
The form assesses demonstrated patient management abilities, technical skills, and procedures in preventive medicine. Evaluators rate each privilege as:
- Acceptable
- Unacceptable (must explain in Section II – Comments)
- Not Applicable
All applicable privileges require evaluation. Ratings factor into reappraisal, renewal of privileges, and medical staff appointment/reappointment.
Section I covers the Department/Service Chief Evaluation with two main categories:
Category I Clinical Privileges
These apply to physicians who completed the AMEDD 6A-F5 Course (Principles of Military Preventive Medicine) or hold a Master of Public Health (MPH) or equivalent. Providers typically serve as installation or unit preventive medicine officers (up to division level).
Key skills include:
- Consultation and policy development for disease control (vaccines, preventive drugs, personal protection).
- Diagnosis/treatment of communicable diseases and public health infections; measures like immunization, chemoprophylaxis, isolation, contact tracing.
- Population screening with health risk appraisals and non-invasive tests.
- Deployment/travel medicine consultations and post-travel illness evaluation.
- Basic occupational medicine services (exams, minor care, worksite evaluations, surveillance).
- Disease/injury surveillance, basic epi investigations, reporting to public health authorities.
- Field preventive medicine support during training and deployments.
Category II Clinical Privileges
These build on Category I and require residency training or board certification in General Preventive Medicine and Public Health (GPM-PH), or equivalent (e.g., Occupational/Aerospace Medicine with advanced epi/public health experience). Providers often serve as Chiefs of Preventive Medicine Services or staff officers at corps level and above.
Advanced skills include:
- Liaison with civilian/military public health authorities.
- Supervision of environmental health services (inspections, vector surveillance, hazard monitoring, sampling, construction reviews).
- Community health needs assessment and interventions.
- Targeted surveillance, data analysis, and new system design.
- Epidemiological studies, outbreak investigations, risk communication.
- Development of preventive medicine procedures and health policy.
- Consultation to Category I providers.
- Public health aspects of nuclear, chemical, and biological (CBRN) weapons preparedness (with specific training noted).
Who Uses This Form?
- Preventive Medicine Physicians (Medical Corps officers).
- Department/Service Chiefs performing evaluations.
- Credentials Committees reviewing for privileging decisions.
- Army medical facilities, including those supporting deployments and operational forces.
It ensures alignment with force health protection goals, such as preventing disease and non-battle injuries (DNBI), supporting readiness, and maintaining compliance with regulations.
How the Privileging Process Works?
- Provider requests privileges on DA Form 5440-47.
- Supervisor/department chief recommends approval levels.
- Credentials committee reviews and recommends.
- Commander (approval authority) grants privileges.
- Performance is evaluated periodically using DA Form 5441-47 (and similar forms for other specialties).
Recent Military Health System updates emphasize streamlined privileging for portability across facilities.
Why It Matters for U.S. Army Medical Professionals?
Preventive medicine is central to military readiness. Providers manage population health, epidemiology, occupational/environmental health, travel medicine, and CBRN threats. Proper privileging via these DA forms upholds high standards of care, patient safety, and mission support.
For the latest guidance, consult AR 40-68 Clinical Quality Management (available on Army Publishing Directorate) and your local medical treatment facility credentials office. Forms are current as of the 2004 editions still in official use.