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Appeal and Hearing Process

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Sample written policy for clinician appeals and hearings related to privileging and appointment.

Application for Clinical Privileges Allied Health Professional Specialty: Family Nurse Practitioner (FNP)

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Application for Clinical Privileges Allied Health Professional Specialty: Family Nurse Practitioner (FNP)

Application for Clinical Privileges Physician Specialty: Dentistry

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Application for Clinical Privileges Physician Specialty: Dentistry

Application for Clinical Privileges Physician Specialty: Family Medicine

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Application for Clinical Privileges
Physician
Specialty: Family Medicine

Appointment Process Flow Chart

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This document outlines the process a health center goes through to appoint a new clinician to staff.

Appointment, Credentialing, & Privileging Guidelines

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Comprehensive Health Center guidelines for privileging, credentialing and appointments.

Clinical Assistant Privileging Request Form for General Care

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Clinical Assistant privileging request form related to nursing abilities, patient well-being, and IVs.

Clinical Assistant Privileging Request Form for Lab Procedures

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Clinical Assistant privileging request form for lab procedures related to In-House Lab Tests and Microscope Use.

Clinical Privileges Request Form- Family Practice Primary Care Providers

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Clinical privileging defines the scope and limits of practice for individual providers. Privileges are based on evaluation of the individual’s credentials and performance. Information on this form may be released to professional organizations if needed to license or monitor professional standards of health care providers. 

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