DA Form 5441-48: Oral & Maxillofacial Surgery Privileges – DA Form 5441-48: Evaluation of Clinical Privileges – Oral & Maxillofacial Surgery is a key U.S. Army document used to assess and grant clinical privileges to providers in oral and maxillofacial surgery (OMS). It supports high-quality, standardized care in military treatment facilities (MTFs) under Army Regulation (AR) 40-68, Clinical Quality Management.
Military healthcare professionals, credentialing officers, and administrators in the U.S. Army frequently search for guidance on this form. This article explains its purpose, contents, usage, and importance for ensuring provider competency in complex surgical procedures.
What Is DA Form 5441-48?
DA Form 5441-48 (February 2004 edition) is the official Evaluation of Clinical Privileges – Oral & Maxillofacial Surgery. Department of the Army uses it alongside DA Form 5440-48 (Delineation of Clinical Privileges) to evaluate a provider’s demonstrated abilities in patient management and technical skills.
The form aligns with AR 40-68 policies for credentialing, privileging, and clinical quality management across Active Army, Army National Guard, and Army Reserve components.
Download the official form here: DA Form 5441-48 PDF.
Purpose and Role in Army Credentialing
Clinical privileging ensures that only qualified providers perform specific procedures. The form evaluates competence based on:
- Training
- Experience
- Performance
Evaluators (typically department/service chiefs) rate each privilege category as Acceptable, Unacceptable, or Not Applicable. Any “Unacceptable” rating requires detailed explanation in Section II – Comments.
This process supports reappraisal, renewal of privileges, and medical staff appointments. It ties into broader DoD and Army quality assurance requirements, including peer review and performance improvement.
Key Sections and Privileges Evaluated
The form organizes privileges into major clinical categories for Oral & Maxillofacial Surgery. Evaluators enter approval codes from the corresponding DA Form 5440-48 and mark performance ratings.
1. Anesthesia
- Nitrous oxide (minimal sedation)
- IV sedation (moderate/deep)
- General anesthesia (ASA 1 and 2)
2. Dentoalveolar Surgery
- Exodontia
- Alveoloplasty
- Exostosis removal
- Vestibuloplasty and soft tissue management
3. Implants
- Intraoral and extraoral endosteal implants
- Cosmetic implants (chin, zygomas, etc.)
4. Pathology
- Biopsies (oral, facial, neck, skin, salivary glands)
- Tumor removal (odontogenic/non-odontogenic)
- Partial resection of maxilla/mandible
- Maxillary sinusotomy
- Salivary gland surgery
- Management of osteoradionecrosis and fistulas
5. Trauma Management
- Repair of facial lacerations
- Closed and open reduction of fractures (mandible, maxilla/Le Fort, nasal, malar, orbital, frontal sinus, zygomatic arch, NOE complex)
- Tracheostomy/cricothyroidotomy
6. Orthognathic Jaw Surgery
- Various Le Fort osteotomies
- Mandibular osteotomies
- Malar osteotomy
7. Reconstruction and Bone Grafts
- Bone harvest (iliac, rib, calvarial, tibial)
- Cartilage, fat, skin grafts
- Nerve harvest
- Cleft lip/palate procedures
- Nerve repairs
- Major flaps (pedicle and microvascular)
8. Facial Cosmetic Procedures
- Alloplastic augmentation
- Blepharoplasty, brow lift, rhytidectomy
- Septorhinoplasty
- Laser procedures
- Botox and resurfacing
9. Miscellaneous
- History and physical examination
- Hospital admission
- Management of oral-cervico-facial infections
The form also covers temporomandibular joint (TMJ) procedures and laser privileges.
How to Use DA Form 5441-48? (Step-by-Step)
- Provider Information — Complete name, rank, evaluation period, department, and facility.
- Section I Evaluation — Department/Service Chief reviews each category, assigns codes, and rates performance.
- Comments — Explain any unacceptable ratings or additional notes.
- Signature — Evaluator signs and dates.
Providers and evaluators must reference the facility’s master privileges list and AR 40-68 guidelines. Updates or modifications require a new form.
Why This Form Matters for U.S. Army Oral & Maxillofacial Surgeons?
OMS providers in the Army handle a broad scope, including trauma, reconstruction, and cosmetic procedures that support readiness and care for service members and families. Proper privileging:
- Maintains patient safety
- Ensures compliance with accreditation standards (e.g., The Joint Commission)
- Supports deployment readiness
Similar processes exist in Air Force and civilian settings, but Army-specific forms like 5441-48 standardize evaluations.
Related Forms and Resources
- DA Form 5440-48 — Delineation (request) of privileges
- AR 40-68 — Clinical Quality Management (primary reference)
- DoD Instruction 6025.13 — Medical Quality Assurance
For current guidance, visit official Army Publishing Directorate (armypubs.army.mil) or consult your MTF credentials office. Forms and regulations may receive updates; always use the latest version.