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I have read the contents of this application, and to the best of my knowledge believe all statements made on this application to be true, correct and complete. Follow the instructions below to complete Hospitalist privilege delineation forms online easily and quickly: Log in to your account.Sample Privileging Forms. TitleTypeCategoryThoracic surgery ‑ Practice area 154White PapersPhysician Practice AreasCardiac surgery ‑ Practice area 136White PapersPhysician Practice AreasInternal Medicine ‑ Practice area 135White PapersPhysician Practice Areas SAMPLE FORMS AND DOCUMENTS ; Worksheet for Consideration of a New Privilege. DEPT OF ORIGIN: City Clerk's Department. TitleTypeCategoryThoracic surgery ‑ Practice area 154White PapersPhysician Practice AreasCardiac surgery ‑ Practice area 136White PapersPhysician Practice AreasInternal Medicine ‑ Practice area 135White PapersPhysician Practice Areas Sample Privileging Forms. Fill out the form in our online filing application. Figure 2 provides a sample form for request of general privileges in emergency medicine and a checklist for specific procedures.