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U.S. Army (DA) Forms in Word: DA 5000-5702 (p. 6 of 12)

All forms are Microsoft Word documents that are completely fillable and easy to use, save, and copy, and we email them directly to you after purchse - usually in just a few minutes!  Our MS Office-certified designers make current, correct, and easy government forms in Word with automatic form fill features. We always do a careful proof of each form to be sure it looks just like the federal form. We are happy to answer questions that you have, and we usually e-mail your document to you right away. The only information we receive from PayPal to contact you is your email address, so if you prefer that we send your form to another e-mail or if you typed it in wrong, e-mail us (forms@formsinword.com) about where to send your form (include your phone number). Thank you for using Forms in Word! Questions? E-mail (fastest way to reach us) or call 907-841-5393 for personalized service!

LINKS TO DA PAGES: DA 2 to 1059-2, DA 1085-R to 1918 DA 1928 to 2985, DA 3020-R to 3999-3-R, DA 4005 to 4999, DA 5000-R to 5703, DA 5704-R to 7223  DA 7223-1 to 7405  DA 7406 to 7496  DA 7500 to 8028 , and New DA Forms (new from 7/04 - 1/06), Army GPO, JCP, OF, OGE, OPM, and SGVL Forms, Army DSC Forms

FORM NO.
FORM TITLE
Price
BUY NOW IN WORD
DA 5000-R

APPLICANT'S INTERVIEW REPORT-JUDGE ADVOCATE GENERAL'S CORPS

$4.99
DA 5006

AUTHORIZATION FOR DISCLOSURE OF INFORMATION

$4.99
DA 5007A

MEDICAL RECORD - ALLERGY IMMUNOTHERAPY RECORD

$4.99
DA 5007B

MEDICAL RECORD - ALLERGY IMMUNOTHERAPY RECORD

$4.99
DA 5008

TELEPHONE MEDICAL ADVICE/CONSULTATION RECORD

$4.99
DA 5009

RELEASE AGAINST MEDICAL ADVICE

$4.99
DA 5011-R

TRAINING EVALUATION SUMMARY

$4.99
DA 5016-R

CHRONOLOGICAL RECORD OF MILITARY SERVICE

$4.99
DA 5017

CIVILIAN EMPLOYEE CONSENT STATEMENT

$4.99
DA 5018-R

ADAPCP CLIENT'S CONSENT STATEMENT FOR RELEASE OF TREATMENT INFORMA- TION

$4.99
DA 5019

CONDITION OF EMPLOYMENT FOR CERTAIN CIVILIAN POSITIONS IDENTIFIED CRITICAL UNDER THE DEPARTMENT OF THE ARMY DRUG-FREE FEDERAL WORKPLACE PROGRAM

$4.99
DA 5026-R

RECORD OF CERTIFICATION SMALL ARMS SHIPMENT CONTROL

$4.99
DA 5027-R

MEDCASE PROGRAM REQUIREMENT

$4.99
DA 5028-R

MEDCASE SUPPORT AND TRANSMITTAL FORM

$4.99
DA 5030

ENGINEER DIVER TRAINING APPLICATION

$4.99
DA 5032-R

FIELD ARTILLERY DELIVERED MINEFIELD PLANNING SHEET

$4.99
DA 5033-R

LIMITED SURFACE OBSERVATION

$4.99
DA 5034-R

PROJECT DOCUMENTATION SPACE ALLOWANCES WORKSHEET

$4.99
DA 5051-10-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OV/RV-1)

$4.99
DA 5051-11-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (AH-64)

$4.99
DA 5051-12-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-58D)

$4.99
DA 5051-1-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-58A/C)

$4.99
DA 5051-2-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (UH-1)

$4.99
DA 5051-4-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (AH-1)

$4.99
DA 5051-5-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (CH-47)

$4.99
DA 5051-7-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-6)

$4.99
DA 5051-9-R

MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (CH-54)

$4.99
DA 5056

ACTEDS INTERN WORK YEAR REQUIREMENTS

$4.99
DA 5070-R

JUSTIFICATION STATEMENT FOR .0015 CONTINGENCY FUNDS

$4.99
DA 5071-R

FUND CUSTODIAN RECEIPT CONTROL AND CASH ACCOUNTABILITY JOURNAL

$4.99
DA 5072

EMERGENCY ACTION STATEMENT

$4.99
DA 5073

MAGNETIC COMPASS DEVIATION TABLE

$4.99
DA 5074-1-R

RECORD OF AWARD OF ENTRY GRADE CREDIT (HEALTH SERVICES OFFICERS)

$4.99
DA 5074-R

RECORD OF AWARD OF ENTRY GRADE CREDIT (MEDICAL AND DENTAL OFFICERS)

$4.99
DA 5075-R

ARTILLERY SURVEY CONTROL POINT

$4.99
DA 5095-A-R

FIRE MISSION SUMMARY (CLASSIFIED WHEN FILLED IN)

$4.99
DA 5095-B-R

FIRE PLAN SUMMARY

$4.99
DA 5100-R

REQUEST FOR SUBSISTENCE PAYROLL DEDUCTION

$4.99
DA 5105

JANITORIAL STANDARDS CHECKLIST

$4.99
DA 5106

MISSION SUPPORT PLAN (MSP)

$4.99
DA 5108-R

DOCUMENTATION FOR PRODUCTIVITY CAPITAL INVESTMENT PROGRAMS

$4.99
DA 5109

REQUEST TO SUPERIOR TO EXERCISE ARTICLE 15, UCMJ, JURISDICTION

$4.99
DA 5110

ARTICLE 15-RECONCILIATION LOG

$4.99
DA 5111

SUMMARY COURT-MARTIAL RIGHTS NOTIFICATION/WAIVER STATEMENT

$4.99
DA 5112

CHECKLIST FOR PRETRIAL CONFINEMENT

$4.99
DA 5117-R

REASSIGNMENT CONTROL SHEET

$4.99
DA 5118

REASSIGNMENT STATUS AND ELECTION STATEMENT

$4.99
DA 5121-R

OVERSEAS TOUR ELECTION STATEMENT

$4.99
DA 5123

IN- AND OUT-PROCESSING RECORDS CHECKLIST

$4.99
DA 5123-1

IN-PROCESSING PERSONNEL RECORD

$4.99
DA 5137-R

APPLICATION FOR VOLUNTARY MOBILIZATION PREASSIGNMENT

$4.99
DA 5138-R

SEPARATION ACTION CONTROL SHEET

$4.99
DA 5142-R

THE INSPECTOR GENERAL ACTION REQUEST SYSTEM (IGARS)DATA

$4.99
DA 5146-R

ASPHALT PAVEMENT INSPECTION SHEET

$4.99
DA 5147-R

SECTION EVALUATION SUMMARY

$4.99
DA 5148-R

PRESENT WORTH COMPUTATION

$4.99
DA 5149-1-R

BRANCH IDENTIFICATION SUMMARY CONTINUATION SHEET

$4.99
DA 5149-R

BRANCH IDENTIFICATION SUMMARY

$4.99
DA 5150-R

SECTION IDENTIFICATION RECORD

$4.99
DA 5151-R

SECTION PAVEMENT STRUCTURE RECORD

$4.99
DA 5152-R

SECTION MATERIALS PROPERTIES RECORD

$4.99
DA 5153-R

SECTION TRAFFIC RECORD

$4.99
DA 5155-R

BRANCH MAINTENANCE & REPAIR REQUIREMENTS

$4.99
DA 5156-R

SECTION MAINTENANCE AND REPAIR RECORD

$4.99
DA 5159

INVENTORY OF ARMY PERSONNEL TEST MATERIAL

$4.99
DA 5160

TEST ADMINISTRATION STATEMENT

$4.99
DA 5161-1-R

FOOD ESTABLISHMENT SANITATION INSPECTION - REMARKS FORM

$4.99
DA 5161-R

COMPREHENSIVE FOOD ESTABLISHMENT INSPECTION

$4.99
DA 5162-R

ROUTINE FOOD ESTABLISHMENT INSPECTION REPORT

$4.99
DA 5163-R

NONAPPROPRIATED FUND CENTRAL PAYROLL SYSTEM TIPS, SERVICE CHARGES AND MEALS REPORT

$4.99
DA 5164-R

HANDS-ON EVALUATION

$4.99
DA 5165-R

FIELD EXPEDIENT SQUAD BOOK

$4.99
DA 5167

INCENTIVE AWARDS NOMINATION AND APPROVAL - NONAPPROPRIATED FUNDS

$4.99
DA 5168-R

SAFETY CLEARANCE ORDER (ELECTRICAL FACILITIES)

$4.99
DA 5170-R

PROPONENT MANAGEMENT INFORMATION REQUIREMENT REVIEW

$4.99
DA 5172-R

REQUEST, AUTHORIZATION, AND REPORT OF OVERTIME

$4.99
DA 5178-R

PROJECT DEVELOPMENT IDENTIFIER (PDI) AND PROJECT DEVELOPMENT SKILL IDENTIFIER (PDSI)

$4.99
DA 5179

MEDICAL RECORD PREOPERATIVE/POSTOPERATIVE NURSING DOCUMENT

$4.99
DA 5179-1

MEDICAL RECORD INTRAOPERATIVE DOCUMENT

$4.99
DA 5179-1 IMAGE 1/2

MEDICAL RECORD INTRAOPERATIVE DOCUMENT

$4.99
DA 5179-1 IMAGE 2/2

MEDICAL RECORD INTRAOPERATIVE DOCUMENT

$4.99
DA 5181

SCREENING NOTE OF ACUTE MEDICAL CARE

$4.99
DA 5182-R

SOIL SUCTION, WATER CONTENT, AND SPECIFIC VOLUME

$4.99
DA 5184

CONSUMER COMPLAINT

$4.99
DA 5187

APPLICATION FOR RESPITE CAREGIVERS

$4.99
DA 5188

MEDICAL REPORT ON APPLICANT FOR CERTIFICATION TO PROVIDE CARE FOR CHILDREN OR ADULTS WITH DISABILITIES

$4.99
DA 5189

APPLICATION FOR RESPITE CARE FOR CHILDREN AND ADULTS WITH DISABILITIES

$4.99
DA 5190

CLINICIAN'S INFORMATION

$4.99
DA 5191

INFORMATION ON INDIVIDUAL WITH DISABILITY

$4.99
DA 5192

FAMILY IDENTIFICATION SHEET FOR A CHILD RECEIVING SERVICE

$4.99
DA 5193

CHILD'S FACE AND WHEREABOUTS SHEET

$4.99
DA 5195

HEALTH DATA

$4.99
DA 5202-R

INTERNATIONL CONTROL IMPROVEMENT ACTIVITIES REPORT

$4.99
DA 5203

DODIC MASTER/LOT LOCATOR RECORD

$4.99
DA 5212-R

PDF SCAN PROJECT

$4.99
DA 5219-R

CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) PROVIDER APPLICATION

$4.99
DA 5220-R

CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) PROVIDER BACKGROUND CLEARANCE REQUEST

$4.99
DA 5221-R

CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/ REVOCATION

$4.99
DA 5222-R

CHILD DEVELOPMENT SERVICES (CDS) SPONSOR CONSENT

$4.99
DA 5223-R

CHILD DEVELOPMENT SERVICES (CDS) CHILD HEALTH ASSESSMENT

$4.99
DA 5224-R

CHILD DEVELOPMENT SERVICES (CDS) CHILD AND FAMILY PROFILE

$4.99
DA 5225-R

CHILD DEVELOPMENT SERVICES (CDS) MEDICAL DISPENSATION RECORD

$4.99
DA 5226-R

CHILD DEVELOPMENT SERVICE (CDS) SPONSOR/ PROGRAM AGREEMENT

$4.99
DA 5227

DA EMPLOYMENT AND MOBILITY AGREEMENT FOR DA ACTEDS INTERNS

$4.99
DA 5228

DEPARTMENT OF THE ARMY PRESIDENTIAL MANAGEMENT INTERN MOBILITY AGREEMENT

$4.99
DA 5234-R

OER CONTROL LOG

$4.99
DA 5235-R

VOLUNTER STATEMENT FOR THE ENLISTED CLUB MANAGEMENT CAREER PROGRAM (MOS OOJ)

$4.99
DA 5237-R

PSNCO EER SUSPENSE ROSTER

$4.99
DA 5239-R

75-, 175- AND 300-METER DOWN RANGE FEEDBACK SCORECARD

$4.99
DA 5239-R IMAGE 1/2

75-, 175- AND 300-METER DOWN RANGE FEEDBACK SCORECARD

$4.99
DA 5239-R IMAGE 2/2

75-, 175- AND 300-METER DOWN RANGE FEEDBACK SCORECARD

$4.99
DA 5241-R

SINGLE AND MULTIPLE TARGETS FIELD FIRING SCORECARD

$4.99
DA 5246-R FILE 1/3

ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT

$4.99
DA 5246-R FILE 2/3

ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT

$4.99
DA 5246-R FILE 3/3

ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT

$4.99
DA 5247-R

REQUEST FOR SECURITY DETERMINATION

$4.99
DA 5248-R

REPORT OF UNFAVORABLE INFORMATION FOR SECURITY DETERMINATION

$4.99
DA 5250

ROTC SCHOLARSHIP - RESERVE FORCES DUTY

$4.99
DA 5251-R

CONAUTH KEY MANAGEMENT WORKSHEET

$4.99
DA 5252-R

STATEMENT - EVIDENCE OF CITIZENSHIP STATUS

$4.99
DA 5257-R

STINGER GUNNER PERFORMANCE EVALUATION SHEET

$4.99
DA 5258-R

REDEYE GUNNER PERFORMANCE EVALUATION SHEET

$4.99
DA 5261-1-R

SELECTED RESERVE INCENTIVE PROGRAM - EDUCATIONAL ASSISTANCE ADDENDUM

$4.99
DA 5261-2-R

SELECTED RESERVE INCENTIVE PROGRAM - REENLISTMENT/EXTENSION BONUS ADDENDUM

$4.99
DA 5261-3-R

SELECTED RESERVE INCENTIVE PROGRAM - AFFILIATION BONUS ADDENDUM

$4.99
DA 5261-4-R

STUDENT LOAN REPAYMENT PROGRAM ADDENDUM

$4.99
DA 5261-5-R

SELECTED RESERVE INCENTIVE PROGRAM - USAR PRIOR SERVICE ENLISTMENT BONUS ADDENDUM

$4.99
DA 5261-R

SELECTED RESERVE INCENTIVE PROGRAM - ENLISTMENT BONUS ADDENDUM

$4.99
DA 5274-R

STANDARD INPUT DATA COMPUTATIONS

$4.99
DA 5275-R

TIME STUDY RECORD

$4.99
DA 5276-R

PROGRAM MANAGEMENT DATA

$4.99
DA 5277-R

OPERATIONAL AUDIT DATA

$4.99
DA 5278-R1

WORK SAMPLING RECORD

$4.99
DA 5278-R2

WORK SAMPLING RECORD

$4.99
DA 5279-R

MANPOWER STANDARD AND TABLE

$4.99
DA 5286

INDIVIDUAL BASIC TRAINING (BT), ADVANCED INDIVIDUAL TRAINING (AIT), ONE STATION UNIT TRAINING (OSUT)

$4.99
DA 5286-1

INDIVIDUAL TRAINING RECORD (CONTINUATION SHEET),BASIC TRAINING (BT), ADVANCED INDIVIDUAL TRAINING (AIT), ONE STATION UNIT TRAINING (OSUT)

$4.99
DA 5289-R

TRAVELING PURCHASE REQUEST

$4.99
DA 5297

ABSTRACT OF VENDOR DELIVERIES

$4.99
DA 5298

OPERTIONAL RATIONS ACCOUNTABILITY

$4.99
DA 5303-R

VOLUNTEER AGREEMENT AFFIDAVIT

$4.99
DA 5304-R

FAMILY CARE PLAN COUNSELING CHECKLIST

$4.99
DA 5305-R

FAMILY CARE PLAN

$4.99
DA 5310-R

FIREFINDER FRIENDLY FIRE

$4.99
DA 5313-1-R

NONAPPROPRIATED FUND PAYABLE/DISBURSEMENT VOUCHER CONTINUATION SHEET

$4.99
DA 5313-R

NONAPPROPRIATED FUND PAYABLE/DISBURSEMENT VOUCHER

$4.99
DA 5315-R

US ARMY ADVANCED EDUCATION FINANCIAL ASSISTANCE RECORD

$4.99
DA 5327

BONA FIDE DEPENDENT DECLARATION - MILITARY

$4.99
DA 5328

BONA FIDE DEPENDENT DECLARATION (CIVILIAN)

$4.99
DA 5329

ESCORT REPORT

$4.99
DA 5330

RELEASE OF REMAINS FOR LOCAL DISPOSITION (OCONUS)

$4.99
DA 5331-R

DESTINATION DEALER'S CERTIFICATION OF TURN-IN OF RENTAL VEHICLE

$4.99
DA 5339

OCS APPLICANT'S COMMANDERS EVALUATION SHEET

$4.99
DA 5353-R

BANK RECONCILIATION WORKSHEET

$4.99
DA 5356-R

PROGRAM WORKSHEET (SB-3614A(V)/TT)

$4.99
DA 5359-R

LONG-RANGE SPECIAL ASSIGNMENT AIRLIFT MISSION (SAAM) FLYING HOUR REQUIREMENTS

$4.99
DA 5367-R

PERSONNEL STATUS REPORT

$4.99
DA 5368

QUICK FIRE PLAN

$4.99
DA 5369-R

ROTATION AGREEMENT - EMPLOYEES RECRUITED FROM THE UNITED STATES

$4.99
DA 5370-R

ROTATION AGREEMENT - EMPLOYEES RECRUITED LOCALLY IN FOREIGN AREA

$4.99
DA 5371-R

ROTATION AGREEMENT - EMPLOYEES RECRUITED FROM THE US TERRITORIES AND POSSESSIONS

$4.99
DA 5372-R

ORIENTATION STATEMENT

$4.99
DA 5373-R

REQUEST FOR PROCESSING OF OVERSEAS SELECTEE

$4.99
DA 5374

PERFORMANCE ASSESSMENT

$4.99
DA 5376-R1

INDIVIDUAL TRAINING EVALUATION RECORD

$4.99
DA 5376-R2

INDIVIDUAL TRAINING EVALUATION RECORD

$4.99
DA 5377-R

FIRE AND EMERGENCY SERVICES TRAINING RECORD

$4.99
DA 5378-R

FACILITY RESPONSE CARD

$4.99
DA 5379-R

APPARATUS MAINTENANCE CHECKLIST

$4.99
DA 5380-R

FIRE APPARATUS TEST RECORD

$4.99
DA 5381-R

BUILDING - FIRE RISK MANAGEMENT SURVEY

$4.99
DA 5382-R

HAZARD/DEFICIENCY INSPECTION RECORD

$4.99
DA 5383-R

HOT-WORK PERMIT

$4.99
DA 5384-R

WATER FLOW TEST

$4.99
DA 5391-R

WORKLOAD MANAGEMENT SYSTEM FOR NURSING

$4.99
DA 5394-1

PRINTING FACILITY PRODUCTIVITY REPORT

$4.99
DA 5396

OVERSEAS TOUR EXTENSION INCENTIVE PROGRAM MONTHLY REPORT

$4.99
DA 5402-R

BARBER/BEAUTY SHOP INSPECTION

$4.99
DA 5409

INOPERATIVE EQUIPMENT REPORT

$4.99
DA 5410

UNIT LEVEL DEADLINING PARTS REPORT

$4.99
DA 5412-R

WAIVER OF COMPENSATION STATEMENT

$4.99
DA 5413-R

CONSULTANT/EXPERT CERTIFICATE

$4.99
DA 5414-R

ADMINISTRATIVE REEMPLOYMENT RIGHTS AGREEMENT

$4.99
DA 5415

GARRISON CATEFORY COMPETITION CHECKLIST

$4.99
DA 5416

FIELD CATEGORY COMPETITION CHECKLIST

$4.99
DA 5417-R Estimate Detail Summary Sheet
$4.99
DA 5422-R

REQUEST FOR BULK FUND ORDER

$4.99
DA 5425-R

APPLICANT/NOMINEE PERSONAL FINANCIAL STATEMENT

$4.99
DA 5426-R

COMMANDER'S EVALUATION

$4.99
DA 5427

COMMANDER'S ASSESSMENT OF RECRUITER CANDIDATE

- updated 11-06
$4.99
DA 5429-R

CONDUCT OF FIRE

$4.99
DA 5433-R

VERIFICATION OF OVERSEAS EMPLOYMENT FOR NONCOMPETITIVE APPOINTMENT UNDER EO 12362

$4.99
DA 5434

SPONSORSHIP PROGRAM COUNSELING AND INFORMATION SHEET

$4.99
DA 5435-R

STATEMENT OF UNDERSTANDING - THE SELECTED RESERVE MONTGOMERY GI BILL(10 USC CHAPTER 1606)

$4.99
DA 5440-1

DELINEATION OF CLINICAL PRIVILEGES - DENTISTRY

$4.99
DA 5440-10

DELINEATION OF CLINICAL PRIVILEGES - PSYCHIATRY

$4.99
DA 5440-11

DELINEATION OF CLINICAL PRIVILEGES - CLINICAL PSYCHOLOGY

$4.99
DA 5440-12

DELINEATION OF CLINICAL PRIVILEGES - DIAGNOSTIC RADIOLOGY

$4.99
DA 5440-13

DELINEATION OF CLINICAL PRIVILEGES - GENERAL SURGERY

$4.99
DA 5440-14

DELINEATION OF CLINICAL PRIVILEGES - NURSE ANESTHETIST

$4.99
DA 5440-15

DELINEATION OF CLINICAL PRIVILEGES - CERTIFIED NURSE MIDWIFE

$4.99
DA 5440-16

DELINEATION OF CLINICAL PRIVILEGES - NURSE PRACTITIONER

$4.99
DA 5440-18

DELINEATION OF CLINICAL PRIVILEGES - PHYSICIAN ASSISTANT

$4.99
DA 5440-19

DELINEATION OF CLINICAL PRIVILEGES - DIETETICS

$4.99
DA 5440-2

DELINEATION OF CLINICAL PRIVILEGES - FAMILY PRACTICE

$4.99
DA 5440-20

DELINEATION OF CLINICAL PRIVILEGES - OCCUPATIONAL THERAPY

$4.99
DA 5440-21

DELINEATION OF CLINICAL PRIVILEGES - PHYSICAL THERAPY

$4.99
DA 5440-22

DELINEATION OF CLINICAL PRIVILEGES

$4.99
DA 5440-23

DELINEATION OF CLINICAL PRIVILEGES - EMERGENCY MEDICINE

$4.99
DA 5440-24

DELINEATION OF CLINICAL PRIVILEGES - AEROSPACE MEDICINE

$4.99
DA 5440-25

DELINEATION OF CLINICAL PRIVILEGES - GENERAL MEDICAL OFFICER

$4.99
DA 5440-28

DELINEATION OF CLINICAL PRIVILEGES

$4.99
DA 5440-29

DELINEATION OF CLINICAL PRIVILEGES - ALLERGY/IMMUNOLOGY

$4.99
DA 5440-3

DELINEATION OF CLINICAL PRIVILEGES - INTERNAL MEDICINE

$4.99
DA 5440-30

DELINEATION OF CLINICAL PRIVILEGES - NEPHROLOGY

$4.99
DA 5440-31

DELINEATION OF CLINICAL PRIVILEGES - CHIROPRACTIC

$4.99
DA 5440-32

DELINEATION OF CLINICAL PRIVILEGES - DERMATOLOGY

$4.99
DA 5440-33

DELINEATION OF CLINICAL PRIVILEGES - UROLOGY

$4.99
DA 5440-34

DELINEATION OF CLINICAL PRIVILEGES - BEHAVIORAL HEALTH PRACTIONER

$4.99
DA 5440-35

DELINEATION OF CLINICAL PRIVILEGES - PSYCHOLOGICAL ASSOCIATE

$4.99
DA 5440-36

DELINEATION OF CLINICAL PRIVILEGES - AUDIOLOGY

$4.99
DA 5440-37

DELINEATION OF CLINICAL PRIVILEGES - SPEECH PATHOLOGY

$4.99
DA 5440-38

DELINEATION OF CLINICAL PRIVILEGES - CLINICAL PHARMACY

$4.99
DA 5440-39

DELINEATION OF CLINICAL PRIVILEGES - NUCLEAR MEDICINE

$4.99
DA 5440-4

DELINEATION OF CLINICAL PRIVILEGES - NEUROLOGY

$4.99
DA 5440-40

DELINEATION OF CLINICAL PRIVILEGES - THERAPEUTIC RADIOLOGY

$4.99
DA 5440-41

DELINEATION OF CLINICAL PRIVILEGES - PHYSICAL MEDICINE AND REHABILITATION

$4.99
DA 5440-42

DELINEATION OF CLINICAL PRIVILEGES - CARDIOLOGY

$4.99
DA 5440-43

DELINEATION OF CLINICAL PRIVILEGES - OPHTHAMOLOGY

$4.99
DA 5440-44

DELINEATION OF CLINICAL PRIVILEGES - OTOLARYNGOLOGY

$4.99
DA 5440-45

DELINEATION OF CLINICAL PRIVILEGES - CARDIOVASCULAR SURGERY

$4.99
DA 5440-46

DELINEATION OF CLINICAL PRIVILEGES - PULMONARY DISEASE

$4.99
DA 5440-47

DELINEATION OF CLINICAL PRIVILEGES - PREVENTIVE MEDICINE

$4.99
DA 5440-48

DELINEATION OF CLINICAL PRIVILEGES - ORAL & MAXILLOFACIAL SURGERY

$4.99
DA 5440-49

DELINEATION OF CLINICAL PRIVILEGES - PLASTIC SURGERY

$4.99
DA 5440-5

DELINEATION OF CLINICAL PRIVILEGES - OBSTETRICS AND GYNECOLOGY

$4.99
DA 5440-50

DELINEATION OF CLINICAL PRIVILEGES - VASCULAR SURGERY

$4.99
DA 5440-51

DELINEATION OF CLINICAL PRIVILEGES - NEUROSURGERY

$4.99
DA 5440-52

DELINEATION OF CLINICAL PRIVILEGES - CRITICAL CARE MEDICINE

$4.99
DA 5440-53

DELINEATION OF CLINICAL PRIVILEGES - OCCUPATIONAL MEDICINE

$4.99
DA 5440-54

DELINEATION OF CLINICAL PRIVILEGES - THORACIC SURGERY

$4.99
DA 5440-55

DELINEATION OF CLINICAL PRIVILEGES - ORTHOPAEDICS

$4.99
DA 5440-56

DELINEATION OF CLINICAL PRIVILEGES - BLOOD SERVICES

$4.99
DA 5440-57

DELINEATION OF CLINICAL PRIVILEGES - PSYCHIATRIC ADVANCED PRACTICE NURSE

$4.99
DA 5440-58

DELINEATION OF CLINICAL PRIVILEGES - SUBSTANCE ABUSE REHABILITATION

$4.99
DA 5440-6

DELINEATION OF CLINICAL PRIVILEGES - OPTOMETRY

$4.99
DA 5440-7

DELINEATION OF CLINICAL PRIVILEGES - PATHOLOGY

$4.99
DA 5440-8

DELINEATION OF CLINICAL PRIVILEGES - PEDIATRICS

$4.99
DA 5440-9

DELINEATION OF CLINICAL PRIVILEGES - PODIATRY

$4.99
DA 5440A

APPROVAL OF CLINICAL PRIVILEGES/STAFF APPOINTMENT

$4.99
DA 5441

EVALUATION OF CLINICAL PRIVILEGES - ANESTHESIA

$4.99
DA 5441-1

EVALUATION OF CLINICAL PRIVILEGES - DENTISTRY

$4.99
DA 5441-10

EVALUATION OF CLINICAL PRIVILEGES - PSYCHIATRY

$4.99
DA 5441-11

EVALUATION OF CLINICAL PRIVILEGES - CLINICAL PSYCHOLOGY

$4.99
DA 5441-12

EVALUATION OF CLINICAL PRIVILEGES - DIAGNOSTIC RADIOLOGY

$4.99
DA 5441-13

EVALUATION OF CLINICAL PRIVILEGES - GENERAL SURGERY

$4.99
DA 5441-14

EVALUATION OF CLINICAL PRIVILEGES - NURSE ANESTHETIST

$4.99
DA 5441-15

EVALUATION OF CLINICAL PRIVILEGES - CERTIFIED NURSE MIDWIFE

$4.99
DA 5441-16

EVALUATION OF CLINICAL PRIVILEGES - NURSE PRACTITIONER

$4.99
DA 5441-18

EVALUATION OF CLINICAL PRIVILEGES - PHYSICIAN ASSISTANT

$4.99
DA 5441-19

EVALUATION OF CLINICAL PRIVILEGES - DIETETICS

$4.99
DA 5441-2

EVALUATION OF CLINICAL PRIVILEGES - FAMILY PRACTICE

$4.99
DA 5441-20

EVALUATION OF CLINICAL PRIVILEGES - OCCUPATIONAL THERAPY

$4.99
DA 5441-21

EVALUATION OF CLINICAL PRIVILEGES - PHYSICAL THERAPY

$4.99
DA 5441-22

EVALUATION OF CLINICAL PRIVILEGES

$4.99
DA 5441-23

EVALUATION OF CLINICAL PRIVILEGES - EMERGENCY MEDICINE

$4.99
DA 5441-24

EVALUATION OF CLINICAL PRIVILEGES - AEROSPACE MEDICINE

$4.99
DA 5441-25

EVALUATION OF CLINICAL PRIVILEGES - GENERAL MEDICAL OFFICER

$4.99
DA 5441-28

EVALUATION OF CLINICAL PRIVILEGES - SOCIAL WORK

$4.99
DA 5441-29

EVALUATION OF CLINICAL PRIVILEGES - ALLERGY/IMMUNOLOGY

$4.99
DA 5441-3

EVALUATION OF CLINICAL PRIVILEGES - INTERNAL MEDICINE

$4.99
DA 5441-30

EVALUATION OF CLINICAL PRIVILEGES - NEPHROLOGY

$4.99
DA 5441-31

EVALUATION OF CLINICAL PRIVILEGES - CHIROPRACTIC

$4.99
DA 5441-32

EVALUATION OF CLINICAL PRIVILEGES - DERMATOLOGY

$4.99
DA 5441-33

EVALUATION OF CLINICAL PRIVILEGES - UROLOGY

$4.99
DA 5441-34

EVALUATION OF CLINICAL PRIVILEGES - BEHAVIORAL HEALTH PRACTITIONER

$4.99
DA 5441-35

EVALUATION OF CLINICAL PRIVILEGES - PSYCHOLOGICAL ASSOCIATE

$4.99
DA 5441-36

EVALUATION OF CLINICAL PRIVILEGES - AUDIOLOGY

$4.99
DA 5441-37

EVALUATION OF CLINICAL PRIVILEGES - SPEECH PATHOLOGY

$4.99
DA 5441-38

EVALUATION OF CLINICAL PRIVILEGES - CLINICAL PHARMACY

$4.99
DA 5441-39

EVALUATION OF CLINICAL PRIVILEGES - NUCLEAR MEDICINE

$4.99