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Appeal and Hearing Process

Sample written policy for clinician appeals and hearings related to privileging and appointment.
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Application for Clinical Privileges Allied Health Professional Specialty: Family Nurse Practitioner (FNP)

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

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Application for Clinical Privileges Physician Specialty: Dentistry

Application for Clinical Privileges Physician Specialty: Dentistry

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Application for Clinical Privileges Physician Specialty: Family Medicine

Application for Clinical Privileges
Physician
Specialty: Family Medicine

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Appointment Process Flow Chart

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

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Appointment, Credentialing, & Privileging Guidelines

Comprehensive Health Center guidelines for privileging, credentialing and appointments.
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Clinical Assistant Privileging Request Form for General Care

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

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Clinical Assistant Privileging Request Form for Lab Procedures

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

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CLINICAL PRIVILEGES IN FAMILY MEDICINE

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Clinical Privileges Request Form- Family Practice Primary Care Providers

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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