Get Old Privilege List With Revisions - Pediatrics - Sutter Medical Center

Filling out the Old Privilege List With Revisions for Pediatrics at Sutter Medical Center is an essential process for healthcare professionals seeking to obtain or renew their privileges. This guide will provide you with a clear and comprehensive overview of each section in the form to assist you in completing it correctly and efficiently.

Follow the steps to fill out the Old Privilege List With Revisions online

1. Click the ‘Get Form’ button to obtain the Old Privilege List With Revisions - Pediatrics and open it in your document editor.
2. Enter your name in the designated space at the top of the form.
3. Indicate whether this is an initial application, a renewal, or an additional request by selecting the appropriate checkbox.
4. Fill in your specialty in the field provided.
5. For each privilege requested, place an 'X' in the request column and note the number of procedures you have performed in the past 24 months in the corresponding box.
6. If applicable, attach a separate written request with documentation of your training and experience for any privileges not listed on the form.
7. Read through the appointment and reappointment requirements for each privilege and ensure you meet these conditions.
8. Complete any additional documentation required for proctoring or verification of performance if requested.
9. Once all sections are filled, review the form for accuracy and completeness.
10. Save your changes, and consider downloading, printing, or sharing the completed form as required.

Complete the Old Privilege List With Revisions online today to ensure your privileges are up to date.