Important Forms:
For current medical staff members who wish to request new clinical privileges, please complete the following:
HCA REQUEST FOR INCREASED OR NEW CLINICAL PRIVILEGES
Fluoroscopy Privileges:
Practitioners requesting fluoroscopy privileges will be required to provide evidence of completion of fluoroscopy training in Healthstream within 90 days of approval of fluoroscopy privileges. Below are instructions on accessing the course.
INSTRUCTIONS FOR HS PLC ACCESS
Proctoring:
For medical staff members who require proctoring, the attached form needs to be completed and returned to the Medical Staff Office upon completion of each
proctored case.
PROCTORING EVALUATION FORM
Non-Recurring Observer Forms:
Anyone who will be entering SDNAMC to observe a privileged Medical Staff provider will need to complete the following forms PRIOR to entering the facility and will need to return them to Jennifer Powers in the Medical Staff Office. By
signing these forms and completing the required HIPAA test, the approved observer will be allowed to shadow a physician for a maximum of 8 hours. Please notify the Medical Staff
Office of the date that the shadowing will occur and to obtain a badge access request form.
Non-Recurring Observation Guidelines-SDH
Non-Recurring Observation Guidelines-HIPAA