Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering your name in the designated field labeled 'Physician Name.' This ensures that the form is correctly attributed to you.
3. Review the Minimum threshold criteria for granting core privileges in interventional cardiology. Ensure that you meet the qualifications outlined, including education and training requirements.
4. If you are a new applicant, gather letters of reference as described: either from your training program director or from relevant department chairs.
5. Complete the section on current experience by detailing the number of percutaneous coronary intervention procedures you have performed in the past 12 months.
6. Follow the instructions to check the requested privileges. Tick the appropriate boxes indicating whether you are requesting, approving, or not approving various core and non-core privileges.
7. Provide current privileges information in the specified section. List any privileges that are not mentioned under core or non-core categories.
8. In the final section, confirm your understanding and compliance with hospital bylaws and the criteria for requested privileges. Sign and date the form at the end.
9. After completing the form, save any changes made. Depending on your preference, you can download, print, or share the form for further processing.

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