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Instructions Privilege List

The doctor has received a delineation of privileges application form that must be completed and returned to the Medical Staff Office. The form requires the doctor to check off in the left column the procedures and services they can independently perform for approval. No items should be checked in the other columns. Once submitted, the application will be reviewed by the department chairman, credentials committee, and medical director for a final decision on privileges. Completing this process in a timely manner is required to maintain a medical staff contract with the hospital.

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30 views

Instructions Privilege List

The doctor has received a delineation of privileges application form that must be completed and returned to the Medical Staff Office. The form requires the doctor to check off in the left column the procedures and services they can independently perform for approval. No items should be checked in the other columns. Once submitted, the application will be reviewed by the department chairman, credentials committee, and medical director for a final decision on privileges. Completing this process in a timely manner is required to maintain a medical staff contract with the hospital.

Uploaded by

lorenza84
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Dear Doctor,

Re: Delineation of Privileges

Please find enclosed a delineation of privileges application form. This should be


reviewed and completed at your earliest convenience. You are advised to
complete this form yourself.

Please check (√) off each item you could do independently and request to be
approved using only the left column and return the application to the Medical
Staff Office (Medical Administration). Remember; do not check any item in column
two (2), or three (3).

If you do not wish to request a particular item, check nothing (do not write NO or X
and leave area blank).

Once we receive the application, it will be sent to the Department Chairman for initial
recommendations and then forwarded to the credentials committee for review. The
Medical Director will then take final action on the delineation of privileges.

Medical Staff contracts at HMC are contingent on completing the above process in a
timely fashion.

If you have any questions, please don’t hesitate to call the Medical Staff Office at
(+974) 439-3019 or 439-3388.

Sincerely,

…………………………
Medical Staff Office
Medical Administration
Hamad Medical Corporation

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