Allied Health Professional Rules and Regulations

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Allied Health Professional Rules and Regulations"

Transcription

1 Allied Health Professional Rules and Regulations I. Purpose To maintain an organized Allied Health Professional Staff committed to promoting effective delivery of patient services, and continuous review and improvement of clinical performance. To provide acceptable quality health care to patients treated at CHRISTUS Santa Rosa Health Care within standards that satisfy or exceed requirements published by the Joint Commission on Accreditation of Healthcare Organizations. II. Professional Standards Allied Health Professionals shall be expected to adhere to and observe the rules of ethics of their respective specialty specific associations and the Ethical Religious Directives for Catholic Health Facilities. III. Definition A. Independent Allied Health Professionals. Individuals not employed by CHRISTUS Santa Rosa Health Care who have completed a formal course of education and training and licensed by the State to perform or function as an independent practitioner. Such individuals may be granted delineated clinical privileges commensurate with their training, skills and experience and shall be required to maintain appropriate state licensure or certification when applicable in one of the allied health professions. Independent Allied Health Professionals are permitted by the State to provide healthcare services within their scope of licensure and training with the requirement for physician oversight and supervision. B. Dependent Allied Health Professionals. Individuals not employed by CHRISTUS Santa Rosa Health Care who have completed a formal course of education and training and licensed or certified by the state or nationally recognized board in one of the allied health professions. Such individuals may be granted defined duties and responsibilities commensurate with their training, skill and experience and shall be required to maintain appropriate licensure or certification when applicable. Dependent Allied Health Professionals are permitted by the State to provide healthcare services within their scope of licensure and training with the requirement for direct physician oversight and supervision. IV. General Requirements for Participation Allied Health Professionals shall be expected to abide by the Bylaws, and Rules and Regulations of the Medical Staff and by such rules and regulations as may from time to time be enacted. Allied Health Professionals shall be required to obtain a physician sponsor who is a current member of the CHRISTUS Santa Rosa Health Care Medical Staff and whose area of specialty relates to the clinical privileges being requested. ahpr&rcsrhc Approved 1008.doc Page 1

2 A. Initial Application Allied Health Professionals shall be required to submit an application with supporting documents which relates in detail to the specific privileges or defined duties and responsibilities requested and the name(s) of the responsible Medical Staff member, as outlined in the "Credentialing" section of this Manual. B. Obligation and Responsibility 1. Maintain current Medical Liability Coverage ($100,000/$300,000). 2. Maintain current specialty specific licensure, board certification, and level of life support certification appropriate to scope of practice, as applicable. Life support certification must be sponsored by the American Heart 3. Participate in specialty specific Continuing Education Programs. Maintain documentation of continuing education specific to training and the clinical privileges or defined duties and responsibilities being requested. 4. Allied Health Professionals shall be expected to abide by and adhere to CHRISTUS Santa Rosa Health Care and Department/Service guidelines, policies and procedures, and rules and regulations, which relate to their approved list of clinical privileges or defined duties and responsibilities. 5. Allied Health Professionals shall be expected to abide by and adhere to Medical Staff bylaws, guidelines, policies and procedures, and rules and regulations, which relate to their approved list of clinical privileges or defined duties and responsibilities 6. Allied Health Professionals may not admit patients in their own name. Their activities in the CHRISTUS Santa Rosa Health Care facilities shall be under the supervision of a current member of the Medical Staff who assumes responsibility for their performance. 7. Unless approved otherwise recorded history and physical examination must be performed by a physician member of the Medical Staff responsible for the management of the medical/surgical conditions during the patient s hospitalization. 8. In the event an Allied Health Professional fails to perform his/her duties and responsibilities in a satisfactory manner, the concern shall be brought to the attention of the sponsoring physician, Chair or Chief of the appropriate Department or Section, and the Director, Physician Services. 9. Maintain a case list documenting hospital activity on an ongoing basis and to forward a copy of such to the Physician Services office annually. ahpr&rcsrhc Approved 1008.doc Page 2

3 V. Clinical Privileges/Defined Duties and Responsibilities C. General Requirements CHRISTUS Santa Rosa Health Care Treatment provided by Allied Health Professionals is limited to those areas of documented competence indicated by the scope of their delineated clinical privileges or defined duties and responsibilities. Allied Health Professionals accorded clinical privileges or defined duties and responsibilities shall be expected to provide services limited to those approved by the CHRISTUS Santa Rosa Health Care Board of Directors on the recommendation of the Medical Board/Medical Executive Committee, Allied Health Professional Subcommittee, Credentials Committee Chair or Chief of the Department or Section, and the appropriate physician sponsor. Independent Allied Health Professionals requesting for additional clinical privileges shall be expected to provide documented evidence of training and/or competence specific to the privileges being requested. Such requests shall be approved by the CHRISTUS Santa Rosa Health Care Board of Directors on the recommendation of the Medical Board/Medical Executive Committee, Allied Health Professional Subcommittee, Credentials Committee, and the Chairperson or Chief of the Department or Section, and the appropriate physician sponsor. D. 90-Day Evaluation Allied Health Professionals on initial appointment shall be evaluated at 90 days of their appointment submitted to the sponsoring physician at least one(1) month prior to the 90 days. The evaluation of activity shall include number of patient contacts, quality of care provided, health status, and current clinical competence. Results of the 90-day review shall be forwarded to the Credentials Committee, the respective Medical Executive Committees and Board of Directors for consideration. E. Annual Competency Evaluation Allied Health Professionals will be evaluated yearly, opposite the year of the reappointment cycle. This evaluation will include the applicant s credentials and current competence. F. Biannual Re-Credentialing / Approval Allied Health Professionals shall be evaluated biannually by the sponsoring physician at least one (1) month prior to the date clinical privileges or defined duties and responsibilities expire. The evaluation of activity shall include number of patient contact, quality of care provided, health status, and current clinical competence. Results of such review and evaluation shall be forwarded to the Credentials Committee, the respective Medical Executive Committees, and the Board of Directors for consideration. ahpr&rcsrhc Approved 1008.doc Page 3

4 V. Credentialing Application for Allied Health Professional delineated clinical privileges or duties and responsibilities shall be processed in accordance with established Medical Staff credentialing and verification procedures and considered for approval or denial by the Allied Health Professional Credentials Subcommittee, Credentials Committee and Medical Board/Medical Executive Committee. Applications shall then be submitted to the CHRISTUS Santa Rosa Health Care Board of Directors for final approval or denial. A. Application Every application for initial appointment must contain complete and accurate information concerning at least the following: 1. Training, including the names and locations of each institution, degrees granted or programs completed, and dates attended; 2. All currently valid professional licensure, registrations and certifications, as well as controlled substances registration, with the date and number of each; 3. Health status including any disabilities affecting the Allied Health Professional's ability to perform patient care duties and exercise the requested clinical privileges and information on any accommodations that may be required; 4. Professional liability insurance coverage as required by the Board and narrative information on malpractice claims history and experience (suits and/or settlements made, whether concluded or pending) during the past five (5) years; 5. The nature and specifics of any investigation or action (whether concluded or pending) involving voluntary or involuntary denial, revocation, suspension, reduction, limitation, probation, non-renewal, failure to seek renewal, withdrawal of application or voluntary/involuntary relinquishment (by resignation or expiration) of any professional license, registration or certificate in any jurisdiction; controlled substances registration; membership or fellowship in local, state or national professional organization; staff membership, status, prerogatives, or clinical privileges at any hospital or other health care entity; 6. Location of office of supervising physician or group, and residence; 7. Names and locations of any other hospital or other health care entities where the practitioner provides or provided health care services with the inclusive dates of each affiliation and the reason for termination of the affiliation; 8. Any current felony charges pending against the Practitioner and any past charges including their resolution; 9. Designation of Department (and Section if available) assignment, Allied Health Professional category, and specific clinical privileges being requested; 10. One letter of recommendation from supervising physician in the form required who have substantive knowledge of the Allied Health Professional's professional competence, ethical character and any other matter requested; 11. An acknowledgment that the applicant has received and read the Allied Health Professional Rules and Regulations and that applicant agrees to be bound by the terms thereof if granted membership and/or clinical privileges; 12. Completion of the following: - Health Screening - Hepatitis B/Waiver - Drug Screening ahpr&rcsrhc Approved 1008.doc Page 4

5 - Background Check; 13. Verification of OIG/MC Sanctions; and 14. An acknowledgment that the applicant has received and read the Orientation packet. B. Effect of the Application. The Allied Health Professional must sign the application and in so doing agrees to comply with the obligations of appointment, as well as: attests to the correctness and completeness of all information furnished; signifies his/her willingness to appear for interviews and provide requested information in connection with his/her application; authorizes and consents to Hospital and Medical Staff representatives consulting with any third parties who may have information bearing on professional competence and conduct or other matters under review and to their inspecting all records and documents pertaining to such information; and releases from any liability all those who, in good faith and without malice, provide, review or act on information regarding the Allied Health Professional's competence, professional ethics, character, health status, and other qualifications for Allied Health Professional appointment and clinical privileges as provided in the Medical Staff Bylaws. C. Appointment Process. 1. Submission of Application. The application for appointment shall be submitted to the Physician Services Department which shall issue appropriate inquiries to third parties and perform verification. An application shall not be considered complete until all requested information has been received. If the application remains incomplete six months after receipt, it will automatically be withdrawn and special notice issued to the applicant. 2. Allied Health Professional Subcommittee. Upon receipt of the complete application, the Physician Services Department shall forward a copy of the application and clinical privileges requested to the Allied Health Professional Subcommittee, the Subcommittee shall review and investigate the Allied Health Professional's qualifications and may interview the Allied Health Professional and request additional information. The Allied Health Professional Subcommittee shall advise the Department chairperson as to whether the Allied Health Professional possesses the necessary qualifications and satisfies the subcommittee's criteria for exercising the clinical privileges requested and whether any conditions should be imposed on his/her exercise of such privileges. If the Allied Health Professional Subcommittee concludes that the Allied Health Professional is not qualified to be granted the requested clinical privileges or should have certain conditions imposed, it shall include the reasons therefore in the recommendation. 3. Department. Each Department chairperson shall review the Allied Health Professional's requested clinical privileges, as recommended by the Allied Health Professional Subcommittee. As necessary, the Department shall review and investigate the Allied Health Professional's qualifications and may interview the Allied Health Professional and request any additional information. The Department chairperson shall advise the Credentials Committee in writing as to ahpr&rcsrhc Approved 1008.doc Page 5

6 whether the Allied Health Professional possesses the necessary qualifications and satisfies the Department s criteria for exercise of the clinical privileges requested and whether any conditions should be imposed on his/her exercise of such privileges. If the Department concludes that the Allied Health Professional is not qualified to be granted the requested clinical privileges or should have certain conditions imposed, it shall include the reasons therefore in the recommendation. 4. Credentials Committee. The Credentials Committee shall review the recommendations of the Allied Health Professional Subcommittee and Department(s) and investigate the qualifications of the Practitioner and shall, within sixty (60) days of receipt of the application and all requested information, issue a written recommendation that the application be accepted, accepted with modifications, or denied. The Credentials Committee shall obtain appropriate peer references and other information, and conduct such other investigation as it finds necessary. As necessary, the Credentials Committee may interview the Allied Health Professional Subcommittee or may appoint a subcommittee to conduct additional investigation. The Credentials Committee s recommendation shall be forwarded to the Medical Board and shall be accompanied by the completed application, results of the investigation and all other documentation considered by the committee. 5. Medical Executive Committee. At its next regular meeting after receipt of a recommendation from the Credentials Committee, the Medical Executive Committee shall review and submit a recommendation to the Board. D. Reappointment Process. 1. Submission of Application. At least one hundred twenty (120) days prior to the expiration of the term of appointment, each Allied Health Professional shall be mailed an application for reappointment form. Each Allied Health Professional who desires reappointment shall, at least ninety (90) days prior to such expiration date, send the completed application for reappointment form to the Credentials Committee. An application shall not be considered complete until all requested information has been received. Following receipt of a complete application for reappointment, the application shall be processed in accord with the procedures set out in this Manual. Failure to return a complete application for reappointment within the time periods required shall result in non-consideration of the application and termination of appointment on the expiration date, without any procedural rights of review. Thereafter, the Allied Health Professional shall be required to submit an initial application which shall be processed pursuant to this Manual. Every application for reappointment must contain complete and accurate information as required in this Manual. 2. Data Collection. Prior to consideration for reappointment, the Physician Services Department shall assemble current information from the Hospital on the Allied Health Professional's activities, performance and conduct in the Hospital ahpr&rcsrhc Approved 1008.doc Page 6

7 during the prior term of appointment. Such information shall be available to the Allied Health Professional Subcommittee, Department and Committees reviewing the reappointment application and should include patterns of care as demonstrated in the findings of quality assurance/improvement activities; participation in relevant internal teaching and continuing education activities; level/amount of clinical activity (patient care contacts at the Hospital); timely accurate completion of medical records and compliance with all applicable records policies; compliance with all Medical Staff Bylaws, Allied Health Professional Rules and Regulations, Policies and Procedures, Manuals and requirements of the Hospital; general attitude toward his/her patients and the Hospital; and cooperativeness in working with other Practitioners, Allied Health Professionals and Hospital personnel. 3. Status Pending Review. Unless action is taken under the provisions of these Allied Health Professional Rules and Regulations regarding corrective action, the current status of a Allied Health Professional seeking reappointment with respect to his/her rights and privileges shall remain in effect during processing and consideration of a complete application for reappointment, pending the outcome of any procedural rights of review and final action by the Board. 4. Procedure for Delineating Privileges Requests. Each application for appointment and reappointment must contain a request for the specific clinical privileges desired by the Practitioner. Specific requests must also be submitted for temporary privileges. 5. Processing Requests. All requests for clinical privileges will be processed according to the procedures outlined herein, as applicable. If a Allied Health Professional already appointed to the Medical Staff requests additional clinical privileges at a time other than in connection with reappointment, the request shall be in writing and processed as a request for initial appointment in accord with the procedures in this Manual. 6. Privilege Determinations. Upon documentation by the Allied Health Professional of satisfaction of the minimum or threshold criteria for the clinical privilege(s) requested, the application shall be considered and granted upon demonstration of current competence. Privileges are granted consistent with the Allied Health Professional's documented training and/or experience in categories of treatment area or procedures, the results of treatment, and the conclusions drawn from quality assessment and improvement activities when available. The Allied Health Professional shall have the burden of establishing his/her qualifications and competence to exercise the clinical privileges being requested. Failure to submit requested information or adequate documentation shall result in the request not being considered. The Allied Health Professional shall not be entitled to any procedural rights of review as a result of such non-consideration. ahpr&rcsrhc Approved 1008.doc Page 7

8 VII. Quality Improvement Allied Health Professionals shall provide continuous quality care for his/her patients treated at CHRISTUS Santa Rosa Health Care and participate in Medical Staff and organizational wide quality improvement activities within their area of specialty. VIII. Specialty Specific Requirements In addition to the General Requirements for Participation, Allied Health Professionals shall be required to satisfy specialty specific guidelines and criteria. A. Independent Allied Health Professionals 1. Advanced Nurse Practitioner a. Employed by a member of the Medical Staff or through an approved agency b. Licensed by the Texas Board of Nursing c. Letter from the Texas Board of Nursing indicating approval to practice as an Advanced Nurse Practitioner d. Basic Life Support (BLS) Certification sponsored by the American Heart e. Advanced Cardiac Life Support (ACLS), Pediatric Advance Life Support (PALS) or Neonatal Resuscitation Program (NRP) certification, as appropriate to scope of practice, sponsored by the American Heart Association and the American Academy of Pediatrics. f. Documentation of current TB test submitted annually; for positive TB g. Current certification, or qualified for such, by the appropriate certification body. Advanced Nurse Practitioners shall be expected to complete and obtain such certification within one year of application. 1) Pediatrics - National Association of Pediatric Nurse Associates and Practitioners or National Certification Board of Pediatric Nurse Practitioners. For PNPs working in the Pediatric Intensive Care Unit, the following is required: Formal completion of an educational program and Board certification as an ACPNP; or current enrollment in a formal educational program leading to certification as an ACPNP to be completed within two years of appointment. 2) Ob/Gyn - National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties or American College of Nurse Midwives or the American Certification of Nurse Midwives Council 3) American Nurses Association - American Nurses Credentialing Center 4) American Academy of Nurse Practitioners 5) Nurse Anesthetist Certified by the Council on certification of Nurse Anesthetists. ahpr&rcsrhc Approved 1008.doc Page 8

9 2. Licensed Professional Psychologist Associate a. Licensed by the Texas State Board of Examiners of Psychologist with provision to render psychological services under supervision of licensed psychologist b. Documentation of current TB test submitted annually; for positive TB 3. Licensed Professional Counselor a. Licensed by the Texas State Board of Examiners of Professional Counselors b. Two (2) years experience as a Licensed Professional Counselor c. Documentation of current TB test submitted annually; for positive TB 4. Perfusionist a. Licensed by the Texas State Board of Examiners of Perfusionist b. Certified by the American Board of Cardiovascular Perfusion (ABCP), or c. Qualified for examination. Individuals qualified for examination shall be expected to actively pursue and successfully attain certification within two (2) years of privileges being granted. d. Basic Life Support (BLS) certification sponsored by the American Heart e. Documentation of current TB test submitted annually; for positive TB 5. Pharmacist a. Licensed by the Texas State Board of Pharmacy b. Certification by Board of Pharmaceutical Specialites or certification by another nationally recognized board (e.g. National Certification Board of Diabetes Educators) or demonstration of significant training and/or experience in specialized area of pharmacy practice. c. Documentation of current TB test submitted annually; for positive TB 6. Physician Assistant a. Certified by the National Commission on Certification of Physician Assistants or ahpr&rcsrhc Approved 1008.doc Page 9

10 b. Qualified for examination. Individuals qualified for examination shall be expected to actively pursue and successfully attain certification within two (2) years of privileges being granted c. Letter from the Texas State Board of Medical Examiners indicating that the Sponsor/Supervising Medical Staff member is an approved supervisor d. Individuals qualified for licensure shall be expected to actively pursue and successfully attain licensure from the Texas State Board of Medical Examiners within two years of clinical privileges being granted. e. Basic Life Support (BLS), Advance Cardiac Life Support (ACLS), or Pediatric Advance Life Support (PALS) certification, as appropriate to scope of practice sponsored by the American Heart f. Documentation of current TB test submitted annually; for positive TB 7. Psychologist Clinical and Counseling a. Licensed at the Doctoral level for the Independent Practice of Psychology by the Texas State Board of Examiners of Psychologists b. Two (2) years experience as a Clinical Psychologist or Counselor c. If the licensed doctoral psychologist does not have the above noted experience, they may be granted privileges that would include concurrent Medical Record review during his/her Provisional year. d. Documentation of current TB test submitted annually; for positive TB 8. Registered Nurse First Assistant a. Licensed by the Texas Board of Nursing b. National certification as a perioperative nurse (CNOR) as recognized by the Certification Board of Perioperative Nursing (CBPN) or licensed and certified as an Advanced Nurse Practitioner c. Documentation of completion of a certified RNFA program as recognized by the Certification Board of Perioperative Nursing (CBPN) d. Minimum of 2 years experience as a Registered Nurse First Assistant or documentation of 150 monitored internship hours during initial credentialing. e. Documentation of current TB test submitted annually; for positive TB f. Copy of current Basic Life Support (BLS) certification, &/or Advanced Cardiac Life Support (ACLS) certification, as appropriate to scope of care, sponsored by the American Heart ahpr&rcsrhc Approved 1008.doc Page 10

11 9. Social Worker a. Licensed by the Texas State Board of Social Workers Examiners as Licensed Master Social Worker - Advanced Clinical Practitioner (CSW-ACP) b. At least three (3) years experience as a certified clinical social worker c. Documentation of current TB test submitted annually; for positive TB B. Dependent Allied Health Professional Dependent Allied Health Professionals shall be required to meet the essential qualifications and minimum requirements of the approved CHRISTUS Santa Rosa Health Care position/job description relevant and applicable to the defined duties and responsibilities being requested. 1. Dental Assistant a. Successful completion of a Dental Assistant Training Course, or b. Documented proof of training and experience in dental office, a minimum of 5 years c. Radiology certificate by the Texas State Board of Dental Examiners d. Basic Life Support (BLS) certification sponsored by the American Heart e. Documentation of current TB test submitted annually; for positive TB 2. Orthopedic Technologist a. Documentation of completion of a certified training program in Orthopedic Technology or documentation of completion of military training b. Current certification as an Orthopedic Technologist from the National Board for Certification of Orthopedic Technologists or registration with the American Society of Orthopedic Professionals c. Basic Life Support (BLS) certification sponsored by the American Heart d. Documentation of current TB test submitted annually; for positive TB 3. Physical Therapist a. Licensed by the Texas State Board of Physical Therapy Examiners b. One year experience as a physical therapist c. Basic Life Support (BLS) certification sponsored by the American Heart ahpr&rcsrhc Approved 1008.doc Page 11

12 d. Documentation of current TB test submitted annually; for positive TB 4. Registered Nurse a. Licensed by the Texas Board of Nursing b. Basic Life Support (BLS) certification sponsored by the American Heart c. Documentation of current TB test submitted annually; for positive TB 5. Research Professional a. Letter from Primary Investigator attesting to competency, skills, character, and specifically delineating your duties as a Research Professional while participating in an IRB/CSRHC approved study. b. Current Texas license, as applicable c. Current certification as qualified for such by the appropriate certification body, as applicable d. Basic Life Support (BLS) certification sponsored by the American Heart Association (if direct patient contact). e. Documentation of current TB test submitted annually; for positive TB 6. Certified Surgical Tech / First Assist a. National certification as a surgical tech/surgical assistant as recognized by the National Board of Surgical Tech & Surgical Assistant (NBST/SA) b. Documentation of completion of a certified surgical tech first assist program as recognized by the National Board of Surgical Tech & Surgical Assistant c. Documentation of current TB test submitted annually; for positive TB d. Copy of current Basic Life Support (BLS) certification sponsored by the American Heart Association 7. Surgical Tech a. Licensed by the Texas Board of Nursing with a minimum of one (1) year experience as a Scrub Nurse, or b. Successful completion of a Surgical Technologist Training course with a minimum of one (1) year experience as a scrub nurse, or ahpr&rcsrhc Approved 1008.doc Page 12

13 c. Licensed by the Texas Board of Vocational Nurse Examiners with a minimum of one (1) year experience as a scrub nurse d. Basic Life Support (BLS) certification sponsored by the American Heart e. Documentation of current TB test submitted annually; for positive TB 8. L.V.N. a. Licensed by the Texas Board of Vocational Nurse Examiners with a minimum of one (1) year experience. b. Basic Life Support (BLS) certification sponsored by the American Heart c. Documentation of current TB test submitted annually; for positive TB 7. Pathology Assistant a. Successful completion of a NAACLS approved training program, or b. Baccalaureate degree with a major or minor in a biological or allied health field with a minimum of three years working experience. c. Registered as a Histologic Technician (HT) by ASCP or other national certifying agency. d. Documentation of current TB test submitted annually; for positive TB 8. Diagnostic Sonographer a. Successful completion of a course in ultrasonic technology b. Minimum six-month experience as an ultrasound technician working in obstetrical and/or perintology setting. c. Basic Life Support (BLS) certification sponsored by the American Heart d. Documentation of current TB test submitted annually; for positive TB IX. Operating Room This section is applicable to all Allied Health Professionals approved for privileges and duties and responsibilities, which require the use of the Operating Room. A. Allied Health Professionals applying for operating room (surgical and anesthesiology) privileges or defined duties and responsibilities shall be interviewed by the Operating ahpr&rcsrhc Approved 1008.doc Page 13

14 Room Administrative Director or Manager who shall evaluate qualifications, review anesthesia and operating room policies, and discuss mutual expectations. B. The Operating Room is not responsible for training Allied Health Professionals who are not directly employed or contracted by CHRISTUS Santa Rosa Health Care. C. Allied Health Professionals shall be expected to maintain and adhere to the same standards, and policies and procedures, which apply to CHRISTUS Santa Rosa Health Care Operating Room personnel. D. In the event that an Allied Health Professional demonstrates unsatisfactory surgical techniques or unacceptable work habits, concerns shall be reported to the sponsoring physician, Administrative Director or Manager and Chairman of the Operating Room Committee. Upon consultation with the sponsoring physician, the Operating Room Committee reserves the right to recommend revision or cancellation of approved Allied Health Professional privileges or defined duties and responsibilities to the Credentials Committee. E. Allied Health Professionals approved for surgical tech staff defined duties and responsibilities shall be expected to function and perform independently and shall accept the responsibilities of his/her position for all elective cases scheduled by his/her sponsoring physician. In the event that a surgical tech staff is not available for an elective scheduled case, the Director of Surgical Services or his/her designee shall be notified of such at least two (2) days prior to the case in order to enable the Operating Room to provide adequate coverage. F. Allied Health Professionals approved for surgical scrub staff defined duties and responsibilities shall be expected to count sponges, instruments, and sharps with the circulating nurse for each case, and remain scrubbed throughout the procedure. G. Allied Health Professionals shall be expected to assume all responsibilities for the care, maintenance, and storage of privately owned specialty instruments and equipment. ahpr&r.doc Orig 9/02 Rev 9/03 Rev 11/03 Rev 03/04 Rev 10/07 Rev 04/08 Rev 05/08 Rev 06/08 Rev 07/08 Rev 10/08 ahpr&rcsrhc Approved 1008.doc Page 14

CREDENTIALING PROCEDURES MANUAL

CREDENTIALING PROCEDURES MANUAL CREDENTIALING PROCEDURES MANUAL Page PART I Appointment Procedures 1 PART II Reappointment Procedures 5 PART III Delineation of Clinical Privileges Procedures 7 PART IV Leave of Absence, Reinstatement,

More information

Credentials Policy Manual. Reviewed & Approved by MEC 8/13/2012 Reviewed & Approved by Board of Commissioners 9/11/12

Credentials Policy Manual. Reviewed & Approved by MEC 8/13/2012 Reviewed & Approved by Board of Commissioners 9/11/12 Credentials Policy Manual Reviewed & Approved by MEC 8/13/2012 Reviewed & Approved by Board of Commissioners 9/11/12 Credentialing Policy Manual Table of Contents I. Application for Appointment to Staff...1

More information

CHRISTUS Santa Rosa HOSPITAL MEDICAL STAFF MEMBERSHIP, CREDENTIALING, PRIVILEGING AND DUE PROCESS MANUAL TABLE OF CONTENTS

CHRISTUS Santa Rosa HOSPITAL MEDICAL STAFF MEMBERSHIP, CREDENTIALING, PRIVILEGING AND DUE PROCESS MANUAL TABLE OF CONTENTS CHRISTUS Santa Rosa HOSPITAL MEDICAL STAFF MEMBERSHIP, CREDENTIALING, PRIVILEGING AND DUE PROCESS MANUAL TABLE OF CONTENTS I. APPOINTMENT AND REAPPOINTMENT PROCEDURE II. PROCEDURES FOR DELINEATING PRIVILEGES

More information

Nonphysician Practitioner Policy a.k.a. Specified Professional Personnel Policy

Nonphysician Practitioner Policy a.k.a. Specified Professional Personnel Policy RENOWN REGIONAL MEDICAL CENTER Nonphysician Practitioner Policy a.k.a. Specified Professional Personnel Policy (The Term Allied Health Professional will not be used in this policy since in the Renown Regional

More information

Doctors Hospital Allied Health Professional Application for Appointment

Doctors Hospital Allied Health Professional Application for Appointment Doctors Hospital Allied Health Professional Application for Appointment Applying for the following job (please check): Allied Health Delineation of Privileges Allied Health Scope of Practice Category 1

More information

DEFINITIONS: The following definitions will apply to this Policy:

DEFINITIONS: The following definitions will apply to this Policy: CLASSIFICATION: MEDICAL STAFF POLICY NUMBER: MS004 EFFECTIVE DATE: 08/91 SUBJECT: Allied Health Professionals DATE REVIEWED/ REVISED: 03/97, 09/01, 06/03, 12/03, 09/04, 11/08, 2/09, 2/10, 3/12, 2/13, 3/13,

More information

Allied Health Care Provider: Appointment and Re-appointment

Allied Health Care Provider: Appointment and Re-appointment Allied Health Care Provider: Appointment and Re-appointment Document Owner: Lawson, Louise Version: 8 Effective Date: 10/23/2013 Revision Date: 4/26/2015 Approvers: Calkins, Paul; Del Boccio, Suzanne;

More information

POLICY ON CREDENTIALING ALLIED HEALTH PROFESSIONALS MIDLAND MEMORIAL HOSPITAL. Midland, Texas 79701

POLICY ON CREDENTIALING ALLIED HEALTH PROFESSIONALS MIDLAND MEMORIAL HOSPITAL. Midland, Texas 79701 POLICY ON CREDENTIALING ALLIED HEALTH PROFESSIONALS At MIDLAND MEMORIAL HOSPITAL Midland, Texas 79701 Date: April 2004 Revision: October 2009 Policy Tech Ref # : 5833 1 Approved: 02/14/2013 Last Reviewed:

More information

APPLICATION FOR ALLIED PROFESSIONAL STAFF

APPLICATION FOR ALLIED PROFESSIONAL STAFF Office of Medical Affairs 736 Irving Ave Syracuse NY 13210 Phone: 315-470-7646 APPLICATION FOR ALLIED PROFESSIONAL STAFF Circle appropriate category CRNA Medical Physicist Research Assistant CST/Dntal

More information

ARTICLE I - DEFINITIONS... 1 ARTICLE II - SCOPE AND OVERVIEW OF POLICY... 2

ARTICLE I - DEFINITIONS... 1 ARTICLE II - SCOPE AND OVERVIEW OF POLICY... 2 PAGE ARTICLE I - DEFINITIONS... 1 ARTICLE II - SCOPE AND OVERVIEW OF POLICY... 2 ARTICLE III - APPLICATION... 3 Section 3.01 - General Qualifications of Applicants... 3 Section 3.02 - No Entitlement to

More information

CREDENTIALING POLICY AND PROCEDURES MANUAL OF THE MEDICAL STAFF OF ADVENTIST HINSDALE HOSPITAL AND ADVENTIST LA GRANGE MEMORIAL HOSPITAL

CREDENTIALING POLICY AND PROCEDURES MANUAL OF THE MEDICAL STAFF OF ADVENTIST HINSDALE HOSPITAL AND ADVENTIST LA GRANGE MEMORIAL HOSPITAL CREDENTIALING POLICY AND PROCEDURES MANUAL OF THE MEDICAL STAFF OF ADVENTIST HINSDALE HOSPITAL AND ADVENTIST LA GRANGE MEMORIAL HOSPITAL Approval: Medical Executive Committees: Hinsdale Hospital July 28,

More information

MGHS CREDENTIALS MANUAL

MGHS CREDENTIALS MANUAL MGHS CREDENTIALS MANUAL POLICY FOR MEMBERSHIP TO THE MARQUETTE GENERAL HEALTH SYSTEM (MGHS) MEDICAL STAFF Applications for Medical Staff membership to MGHS shall be provided to physicians, dentists, podiatrists,

More information

II. INTERDISCIPLINARY PRACTICE COMMITTEE (IPC)

II. INTERDISCIPLINARY PRACTICE COMMITTEE (IPC) Rules and Regulations and Credentialing and Privileging Policy Advanced Practice Professionals and Ancillary Staff Interdisciplinary Practice Committee I. CATEGORIES The Medical Executive Committee (MEC)

More information

Surgical Center of Greensboro/Orthopaedic Surgical Center Div of Surgical Care Affiliates

Surgical Center of Greensboro/Orthopaedic Surgical Center Div of Surgical Care Affiliates Allied Health Staff Application Instructions We are pleased to provide you with our Allied Health Staff application packet. Please do not write see attached or see resume or CV on the application. All

More information

UNIVERSITY OF NORTH CAROLINA HOSPITALS

UNIVERSITY OF NORTH CAROLINA HOSPITALS 7 1 BYLAWS OF THE MEDICAL STAFF UNIVERSITY OF NORTH CAROLINA HOSPITALS Approved by the Executive Committee of the Medical Staff, November 5, 2001. Approved by the Medical Staff, December 5, 2001. Approved

More information

TITLE: Allied Health Professional Policy

TITLE: Allied Health Professional Policy TITLE: Allied Health Professional Policy Number: Version: Status: Current Type: Medical Staff Policy Author: Medical Staff Original Date: Revised Dates: Review Cycle: Triennial Deactivation Date: Facility:

More information

Initial Credentialing Application: Certified Registered Nurse Anesthetist (CRNA)

Initial Credentialing Application: Certified Registered Nurse Anesthetist (CRNA) Updated 1/1/2013 Specialty Surgery Center Initial Credentialing Application: Certified Registered Nurse Anesthetist (CRNA) Dear Anesthesia Provider, Thank you for your interest in providing services at

More information

Stanford Hospital and Clinics Lucile Packard Children s Hospital

Stanford Hospital and Clinics Lucile Packard Children s Hospital Practitioners Page 1 of 10 I. PURPOSE To outline individuals who are authorized to provide care as an Allied Health professional as well as describe which categories of individuals who will be processed

More information

MEDICAL STAFF POLICY & PROCEDURE

MEDICAL STAFF POLICY & PROCEDURE 240 Maple Street PO Box 470 Woodruff, WI 54568 (715) 356-8000 MEDICAL STAFF POLICY & PROCEDURE NUMBER: MS.4 EFFECTIVE/APPROVAL DATE: TITLE: CREDENTIALING POLICY REVISION DATE: 4/97; 1/98; 7/98; 2/99; 12/00;

More information

MOONLIGHTING INSTRUCTIONS:

MOONLIGHTING INSTRUCTIONS: MOONLIGHTING INSTRUCTIONS: Please Complete and Send the Forms on the Following 6 Pages to the Medical Staff Office at Box URMFG 278911. 1) URMC Moonlighting (extra work shift) Request Form, p. 1 of 6 2)

More information

EFFECTIVE DATE: 10/04. SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31

EFFECTIVE DATE: 10/04. SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31 SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31 EFFECTIVE DATE: 10/04 Applies to all products administered by the plan except when changed by contract Policy Statement:

More information

POLICY REGARDING ADVANCED PRACTICE NURSES, PHYSICIAN ASSISTANTS AND OTHER CREDENTIALED HEALTH CARE PROVIDERS

POLICY REGARDING ADVANCED PRACTICE NURSES, PHYSICIAN ASSISTANTS AND OTHER CREDENTIALED HEALTH CARE PROVIDERS MEDICAL-DENTAL STAFF BYLAWS, POLICIES, AND RULES AND REGULATIONS OF CHRISTIANA CARE HEALTH SERVICES, INC POLICY REGARDING ADVANCED PRACTICE NURSES, PHYSICIAN ASSISTANTS AND OTHER CREDENTIALED HEALTH CARE

More information

MARTIN HEALTH SYSTEM

MARTIN HEALTH SYSTEM MARTIN HEALTH SYSTEM CREDENTIALING PROCEDURES MANUAL FOR ALLIED HEALTH PROFESSIONALS/DEPENDENT PRACTITIONERS Last Amended September 24, 2014 Approved 04/2012 Last reviewed in its entirety by Medical Staff

More information

ST. JOHN S HOSPITAL-ALLIED HEALTH PROFESSIONALS ADVANCED PRACTICE NURSE IN THE EMERGENCY DEPARTMENT

ST. JOHN S HOSPITAL-ALLIED HEALTH PROFESSIONALS ADVANCED PRACTICE NURSE IN THE EMERGENCY DEPARTMENT ST. JOHN S HOSPITAL-ALLIED HEALTH PROFESSIONALS ADVANCED PRACTICE NURSE IN THE EMERGENCY DEPARTMENT (APN) In accordance with the Nursing and Advanced Practice Nursing Act (225 ILCS 65) (the Act ), the

More information

North Carolina Department of Insurance. Uniform Application. To Participate as a Health Care Practitioner

North Carolina Department of Insurance. Uniform Application. To Participate as a Health Care Practitioner orth Carolina Department of Insurance Uniform Application To Participate as a Health Care Practitioner ote: Please send completed applications directly to the organizations with which you seek to contract.

More information

PLATTE COUNTY MEMORIAL HOSPITAL MEDICAL STAFF CREDENTIALING POLICY ARTICLE I DEFINITIONS

PLATTE COUNTY MEMORIAL HOSPITAL MEDICAL STAFF CREDENTIALING POLICY ARTICLE I DEFINITIONS PLATTE COUNTY MEMORIAL HOSPITAL MEDICAL STAFF CREDENTIALING POLICY ARTICLE I DEFINITIONS The following definitions shall apply to terms used in this policy: (1) "Board" means the Board of Directors of

More information

MEDICAL STAFF BYLAWS FOR CHILDREN'S & WOMEN'S HEALTH CENTRE OF BRITISH COLUMBIA AN AGENCY OF THE PROVINICAL HEALTH SERVICES AUTHORITY

MEDICAL STAFF BYLAWS FOR CHILDREN'S & WOMEN'S HEALTH CENTRE OF BRITISH COLUMBIA AN AGENCY OF THE PROVINICAL HEALTH SERVICES AUTHORITY MEDICAL STAFF BYLAWS FOR CHILDREN'S & WOMEN'S HEALTH CENTRE OF BRITISH COLUMBIA AN AGENCY OF THE PROVINICAL HEALTH SERVICES AUTHORITY SEPTEMBER 1, 2004 Board Approved June 24, 2004 Ministry of Health Approved

More information

ALLIED HEALTH PROFESSIONALS MANUAL

ALLIED HEALTH PROFESSIONALS MANUAL ALLIED HEALTH PROFESSIONALS MANUAL Allen Memorial Hospital Waterloo, Iowa Reviewed & Revised: November 2011 New: January 2005 Replaces: Sections of Medical Staff Manual and Credentials Manual ALLEN MEMORIAL

More information

Policies of the University of North Texas Health Science Center. Chapter 14 UNT Health. 14.340 Credentialing and Privileging Licensed Practitioners

Policies of the University of North Texas Health Science Center. Chapter 14 UNT Health. 14.340 Credentialing and Privileging Licensed Practitioners Policies of the University of North Texas Health Science Center 14.340 Credentialing and Privileging Licensed Practitioners Chapter 14 UNT Health Policy Statement. UNT Health shall credential and grant

More information

Dental Initial Credentialing Application

Dental Initial Credentialing Application Dental Initial Credentialing Application Practitioner and Practice Information Name(last) (First) (Middle) Degree Social Security Number Personal NPI Date of Birth Gender Practice Name Practice Taxpayer

More information

Ontario Hospital Association/Ontario Medical Association Hospital Prototype Board-Appointed Professional Staff By-law

Ontario Hospital Association/Ontario Medical Association Hospital Prototype Board-Appointed Professional Staff By-law Ontario Hospital Association/Ontario Medical Association Hospital Prototype Board-Appointed Professional Staff By-law 2011 ONTARIO HOSPITAL ASSOCIATION/ ONTARIO MEDICAL ASSOCIATION HOSPITAL PROTOTYPE BOARD-APPOINTED

More information

UNIVERSITY OF MARYLAND MEDICAL CENTER MEDICAL STAFF BYLAWS

UNIVERSITY OF MARYLAND MEDICAL CENTER MEDICAL STAFF BYLAWS UNIVERSITY OF MARYLAND MEDICAL CENTER MEDICAL STAFF BYLAWS TABLE OF CONTENTS DEFINITIONS. 1 ARTICLE 1. NAME & MISSION. 3 ARTICLE 2. PURPOSE AND AUTHORITY.. 4 ARTICLE 3. MEMBERSHIP 6 ARTICLE 4. CATEGORIES

More information

COMMUNITY HEALTH NETWORK ALLIED HEALTH PROFESSIONAL POLICY MANUAL

COMMUNITY HEALTH NETWORK ALLIED HEALTH PROFESSIONAL POLICY MANUAL COMMUNITY HEALTH NETWORK ALLIED HEALTH PROFESSIONAL POLICY MANUAL OBJECTIVE: To establish the method by which Allied Health Professionals may be granted clinical privileges and appointment to the Allied

More information

02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION. Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING

02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION. Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING 02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 380 BOARD OF NURSING Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING SUMMARY: This chapter identifies the role of a registered

More information

Your Hearing Network Application and Credentialing Agreement.

Your Hearing Network Application and Credentialing Agreement. Your Hearing Network Application and Credentialing Agreement. Use this checklist to ensure the application you are submitting is complete. Credentialing application: 1. Fully completed application (one

More information

New Jersey Physician Recredentialing Application (Please type or print)

New Jersey Physician Recredentialing Application (Please type or print) New Jersey Physician Recredentialing Application (Please type or print) All sections must be completed fully or clearly marked as not applicable. No area should be left blank. SECTION 1 Personal Information

More information

BYLAWS OF NORTHWEST HOSPITAL MEDICAL STAFF

BYLAWS OF NORTHWEST HOSPITAL MEDICAL STAFF NORTHWEST HOSPITAL & MEDICAL CENTER Seattle, Washington BYLAWS OF NORTHWEST HOSPITAL MEDICAL STAFF Effective Date: October 19, 2012 BYLAWS OF NORTHWEST HOSPITAL MEDICAL STAFF TABLE OF CONTENTS PAGE ARTICLE

More information

Ratified: June 6, 2013 PROFESSIONAL STAFF BY-LAW

Ratified: June 6, 2013 PROFESSIONAL STAFF BY-LAW Ratified: June 6, 2013 PROFESSIONAL STAFF BY-LAW ARTICLE 1 DEFINITIONS AND INTERPRETATION...4 Section 1.1 Definitions...4 Section 1.2 Interpretation...6 Section 1.3 Delegation of Duties...6 Section 1.4

More information

LOCUM TENENS APPLICATION Page 1 of 4

LOCUM TENENS APPLICATION Page 1 of 4 Page 1 of 4 This form is only valid for Locum Tenens providing coverage for up to 60 days. SECTION I PROVIDER INFORMATION This section to be completed by the PacificSource participating practitioner. Please

More information

Mercy Hospital Medical Staff Credentialing Manual

Mercy Hospital Medical Staff Credentialing Manual CREDENTIALING MANUAL APPROVED BY BYLAWS COMMITTEE MAY 22, 2007 Mercy Hospital Medical Staff Credentialing Manual Approved by the Medical Executive Committee: Mercy Hospital Anderson: January 21, 2008 Mercy

More information

CRAIG HOSPITAL ENGLEWOOD, COLORADO BYLAWS OF THE MEDICAL STAFF ADOPTED AS AMENDED: MARCH 26, 2015

CRAIG HOSPITAL ENGLEWOOD, COLORADO BYLAWS OF THE MEDICAL STAFF ADOPTED AS AMENDED: MARCH 26, 2015 CRAIG HOSPITAL ENGLEWOOD, COLORADO BYLAWS OF THE MEDICAL STAFF ADOPTED AS AMENDED: MARCH 26, 2015 BYLAWS OF THE MEDICAL STAFF 48355590.5 TABLE OF CONTENTS PAGE PREAMBLE... 1 DEFINITIONS...1 ARTICLE I.

More information

CREDENTIALING POLICY FOR ALLIED HEALTH PROFESSIONALS

CREDENTIALING POLICY FOR ALLIED HEALTH PROFESSIONALS CREDENTIALING POLICY FOR ALLIED HEALTH PROFESSIONALS TABLE OF CONTENTS Article Page 1 DEFINITIONS.. 1 2 SCOPE AND OVERVIEW OF POLICY 2.1 Scope of Policy 3 2.2 Classification of Allied Health Professionals..

More information

POLICY No. 20-049. Prepared by: Judith Kell Effective: December 20, 2002 Compliance Review Supervisor Revised: January 23, 2009

POLICY No. 20-049. Prepared by: Judith Kell Effective: December 20, 2002 Compliance Review Supervisor Revised: January 23, 2009 LAKESHORE BEHAVIORAL HEALTH ALLIANCE Community Mental Health Services of Muskegon County Community Mental Health of Ottawa County Lakeshore Coordinating Council for Substance Abuse Services POLICY Prepared

More information

1) ELIGIBLE DISCIPLINES

1) ELIGIBLE DISCIPLINES PRACTITIONER S APPLICABLE TO ALL INDIVIDUAL NETWORK PARTICIPANTS AND APPLICANTS FOR THE PREFERRED PAYMENT PLAN NETWORK, MEDI-PAK ADVANTAGE PFFS NETWORK AND MEDI-PAK ADVANTAGE LPPO NETWORK. 1) ELIGIBLE

More information

Rehab Net of Arkansas. Provider Application

Rehab Net of Arkansas. Provider Application Rehab Net of Arkansas Provider Application Discipline P.T. O.T. S.L.P. (1) Business Name Physical Address FACILITY DATA Phone Fax (2) Billing Address Phone Fax (3) Mailing Address (4) Owner/Contact Person

More information

Resident Credentialing Policy Wayne State University

Resident Credentialing Policy Wayne State University Resident Credentialing Policy Wayne State University REQUIREMENTS FOR INITIAL RESIDENT APPOINTMENT Residency Office Responsibilities: 1. Resident Initial Appointment Recommendation Letter: Initial applications

More information

Revised July 2014 MEDICAL STAFF BYLAWS OF MINISTRY OUR LADY OF VICTORY HOSPITAL, INC.

Revised July 2014 MEDICAL STAFF BYLAWS OF MINISTRY OUR LADY OF VICTORY HOSPITAL, INC. MEDICAL STAFF BYLAWS OF MINISTRY OUR LADY OF VICTORY HOSPITAL, INC. DEFINITIONS 1. MEDICAL STAFF means all Doctors of Medicine, Doctors of Osteopathy, Doctors of Dentistry and Doctors of Podiatry, who

More information

CREDENTIALING POLICY OF UNIVERSITY OF UTAH HOSPITAL AND CLINICS

CREDENTIALING POLICY OF UNIVERSITY OF UTAH HOSPITAL AND CLINICS CREDENTIALING POLICY OF UNIVERSITY OF UTAH HOSPITAL AND CLINICS Revised November, 2004 TABLE OF CONTENTS PAGE 1. DEFINITIONS...1 1.A DEFINITIONS...1 1.B TIME LIMITS...2 1.C DELEGATION OF FUNCTIONS...2

More information

APPENDIX A MEDICAL STAFF CREDENTIALING POLICY

APPENDIX A MEDICAL STAFF CREDENTIALING POLICY APPENDIX A MEDICAL STAFF CREDENTIALING POLICY 1 TABLE OF CONTENTS 12/4/07 Version ARTICLE I: MEDICAL STAFF MEMBERSHIP...3 A. QUALIFICATIONS FOR MEMBERSHIP AND CLINICAL PRIVILEGES...3 1. General...3 2.

More information

Accreditation Handbook of Urgent Care Centers

Accreditation Handbook of Urgent Care Centers Accreditation Handbook of Urgent Care Centers Urgent Care Center Accreditation of America 813 S. Hiawassee Rd., Suite 206 Orlando, FL 32835-6690 Ph 407-521-5789 Fax 407-521-5790 www.aaucm.org Accreditation

More information

240 Maple Street PO Box 470 Woodruff, WI 54568 (715) 356-8000

240 Maple Street PO Box 470 Woodruff, WI 54568 (715) 356-8000 240 Maple Street PO Box 470 Woodruff, WI 54568 (715) 356-8000 Medical Staff Policy & Procedure NUMBER: MS.3 Effective/Approval Date: February 17, 1998 TITLE: ALLIED HEALTH PROFESSIONALS Revised 6/98; 5/99;

More information

WCHO PIHP POLICY for the COMMUNITY MENTAL HEALTH PARTNERSHIP OF SOUTHEASTERN MICHIGAN Department: Business Finance Administration Author: S.

WCHO PIHP POLICY for the COMMUNITY MENTAL HEALTH PARTNERSHIP OF SOUTHEASTERN MICHIGAN Department: Business Finance Administration Author: S. WCHO PIHP POLICY for the COMMUNITY MENTAL HEALTH PARTNERSHIP OF SOUTHEASTERN MICHIGAN Department: Business Finance Administration Author: S. Reitmeier Date: Reason: Revision Date 03/07, 10/09 Policy and

More information

WRAPAROUND MILWAUKEE Policy & Procedure

WRAPAROUND MILWAUKEE Policy & Procedure WRAPAROUND MILWAUKEE Policy & Procedure Wraparound Wraparound-REACH FISS Project O-Yeah I. POLICY Date Issued: 11/15/07 Effective Date: 1/1/15 Reviewed: 10/20/14 By: WA Last Revision: 10/20/14 Subject:

More information

LEGISLATIVE RESEARCH COMMISSION PDF VERSION

LEGISLATIVE RESEARCH COMMISSION PDF VERSION CHAPTER 126 PDF p. 1 of 7 CHAPTER 126 (SB 206) AN ACT relating to relating to health practitioners. Be it enacted by the General Assembly of the Commonwealth of Kentucky: SECTION 1. A NEW SECTION OF KRS

More information

Public Act No. 10-38

Public Act No. 10-38 1 of 8 8/27/2010 10:34 AM Substitute House Bill No. 5286 Public Act No. 10-38 AN ACT CONCERNING LICENSURE OF MASTER AND CLINICAL SOCIAL WORKERS. Be it enacted by the Senate and House of Representatives

More information

McLaren Greater Lansing Rules of the Department of Emergency Medicine ARTICLE I. PURPOSE AND ORGANIZATION

McLaren Greater Lansing Rules of the Department of Emergency Medicine ARTICLE I. PURPOSE AND ORGANIZATION McLaren Greater Lansing Rules of the Department of Emergency Medicine ARTICLE I. PURPOSE AND ORGANIZATION 1.1 PURPOSE 1.1.1 The purpose of the Department of Emergency Medicine shall be to perform the organizational

More information

MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY, INC. POLICY & PROCEDURES

MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY, INC. POLICY & PROCEDURES NUMBER: PAGE: 1 OF: 12 ADOPTED FROM: NACHC REVIEWED BY: Executive Team, Board of Directors DATES OF REVISION: APPROVED: July 21, 2011 DATES OF REVIEW: July 21, 2011 1. POLICY: This policy applies to all

More information

CREDENTIALING PLAN SECTION ONE INDIVIDUAL PROVIDERS

CREDENTIALING PLAN SECTION ONE INDIVIDUAL PROVIDERS CREDENTIALING PLAN SECTION ONE INDIVIDUAL PROVIDERS I. STATEMENT OF POLICY A. The purpose of Avera Credentialing Verification Service (CVS) is to provide credentialing and recredentialing primary source

More information

CREDENTIALING OF PROVIDERS

CREDENTIALING OF PROVIDERS Page Number 1 of 8 TITLE: CREDENTIALING OF PROVIDERS PURPOSE: The Center for Health Care Services (CHCS) will ensure each provider possesses the required education, certification or license, training,

More information

Diagnostic and Treatment Center MEDICAL STAFF BYLAWS PREAMBLE

Diagnostic and Treatment Center MEDICAL STAFF BYLAWS PREAMBLE Diagnostic and Treatment Center MEDICAL STAFF BYLAWS PREAMBLE WHEREAS, the Diagnostic and Surgical Services Center, L.L.C. ( Diagnostic and Treatment Center ) organized as a Wisconsin Limited Liability

More information

GENESEE COUNTY Date Issued: 01-1999 COMMUNITY MENTAL HEALTH Date Revised: 08-2011 PIHP POLICY MANUAL SUBJECT:

GENESEE COUNTY Date Issued: 01-1999 COMMUNITY MENTAL HEALTH Date Revised: 08-2011 PIHP POLICY MANUAL SUBJECT: GENESEE COUNTY Date Issued: 01-1999 COMMUNITY MENTAL HEALTH Date Revised: 08-2011 PIHP POLICY MANUAL SUBJECT: Page 1 of 7 WRITTEN BY: T. Deeghan, COO TECHNICAL REVIEW BY: T. Deeghan, S. Mason AUTHORIZED

More information

EL CAMINO AMBULATORY SURGERY CENTER MEDICAL STAFF BYLAWS DEFINITIONS

EL CAMINO AMBULATORY SURGERY CENTER MEDICAL STAFF BYLAWS DEFINITIONS El Camino Ambulatory Surgery Center, LLC 2480 Grant Road Mountain View, CA 94040 EL CAMINO AMBULATORY SURGERY CENTER MEDICAL STAFF BYLAWS Whereas, El Camino Ambulatory Surgery Center, LLC, organized under

More information

HOUSE BILL No. 2577 page 2

HOUSE BILL No. 2577 page 2 HOUSE BILL No. 2577 AN ACT enacting the addictions counselor licensure act; amending K.S.A. 74-7501 and K.S.A. 2009 Supp. 74-7507 and repealing the existing section; also repealing K.S.A. 65-6601, 65-6602,

More information

ALLIED HEALTH PROFESSIONAL POLICIES AND PROCEDURES

ALLIED HEALTH PROFESSIONAL POLICIES AND PROCEDURES PROVIDENCE HEALTH & SERVICES OREGON ALLIED HEALTH PROFESSIONAL POLICIES AND PROCEDURES Providence Hood River Memorial Hospital Providence Medford Medical Center Providence Milwaukie Hospital Providence

More information

Ohio Department of Insurance

Ohio Department of Insurance Ohio Department of Insurance STANDARDIZED CREDENTIALING FORM Please complete each section thoroughly. Attach additional sheets where necessary. Type or print clearly in black ink. Sign and date the application.

More information

Lakeshore RE AFP POLICY # 4.4. APPROVED BY: Board of Directors

Lakeshore RE AFP POLICY # 4.4. APPROVED BY: Board of Directors Lakeshore PIHP POLICY TITLE: CREDENTIALING, RECREDENTIALING, STAFF QUALIFICATIONS, AND BACKGROUND CHECKS Topic Area: Provider Network Management POLICY # 4.4 Page: 1 of ISSUED BY: Chief Executive Officer

More information

Appendix B-2 Acceptance/continued participation criteria Primary care physician assistants

Appendix B-2 Acceptance/continued participation criteria Primary care physician assistants Appendix B-2 Acceptance/continued participation criteria Primary care physician assistants Amendments to this Appendix B-2 shall be effective as of August 1, 2012 (the Amendment Date ). To be initially

More information

78th OREGON LEGISLATIVE ASSEMBLY--2015 Regular Session. Senate Bill 430 SUMMARY

78th OREGON LEGISLATIVE ASSEMBLY--2015 Regular Session. Senate Bill 430 SUMMARY Sponsored by Senator KRUSE (Presession filed.) th OREGON LEGISLATIVE ASSEMBLY--0 Regular Session Senate Bill 0 SUMMARY The following summary is not prepared by the sponsors of the measure and is not a

More information

Kenmore Mercy Hospital Medical Staff, Bylaws

Kenmore Mercy Hospital Medical Staff, Bylaws Kenmore Mercy Hospital Medical Staff, Bylaws Effective: 1/23/08 Revised: 2/18/09, 10/20/10, 2/16/12, 6/21/12, 12/12/12, 5/9/13 TABLE OF CONTENTS Preamble.. 3 Article One: Article Two: Article Three: Article

More information

CHAPTER 152 SENATE BILL 1362 AN ACT

CHAPTER 152 SENATE BILL 1362 AN ACT Senate Engrossed State of Arizona Senate Fiftieth Legislature Second Regular Session 0 CHAPTER SENATE BILL AN ACT AMENDING SECTION -0, ARIZONA REVISED STATUTES; AMENDING TITLE, CHAPTER, ARTICLE, ARIZONA

More information

LIBERTY DENTAL PLAN Provider Credentialing Application

LIBERTY DENTAL PLAN Provider Credentialing Application (Complete one application per Provider) (* Required Fields) Credentialing Information: Owner: Associate: *PROVIDER NAME: DDS DMD Other (specify) *DATE OF BIRTH: / / Gender: Male Female Owning Dentist Name:

More information

EFFECTIVE NEBRASKA HEALTH AND HUMAN SERVICES 172 NAC 100 7/21/04 REGULATION AND LICENSURE PROFESSIONAL AND OCCUPATIONAL LICENSURE TABLE OF CONTENTS

EFFECTIVE NEBRASKA HEALTH AND HUMAN SERVICES 172 NAC 100 7/21/04 REGULATION AND LICENSURE PROFESSIONAL AND OCCUPATIONAL LICENSURE TABLE OF CONTENTS TITLE 172 CHAPTER 100 PROFESSIONAL AND OCCUPATIONAL LICENSURE ADVANCED PRACTICE REGISTERED NURSE TABLE OF CONTENTS SUBJECT CODE SECTION PAGE Administrative Penalty 010 23 Continuing Competency 004 8 Definitions

More information

BYLAWS OF THE MEDICAL STAFF

BYLAWS OF THE MEDICAL STAFF (EFFECTIVE 6.25.12) BYLAWS OF THE MEDICAL STAFF CENTRAL MAINE MEDICAL CENTER LEWISTON, MAINE With updates adopted by the Medical Staff on June 25, 2012 Edmund Claxton, M.D. President Approved by the Governing

More information

Appendix B-1 Acceptance/continued participation criteria Primary care nurse practitioner

Appendix B-1 Acceptance/continued participation criteria Primary care nurse practitioner Appendix B-1 Acceptance/continued participation criteria Primary care nurse practitioner Amendments to this Appendix B-1 shall be effective as of August 1, 2012 (the Amendment Date ). To be initially admitted

More information

Departmental Policy. Nurse Credentialing and the Nurse Credentialing Committee

Departmental Policy. Nurse Credentialing and the Nurse Credentialing Committee Page 1 of 6 Nurse Credentialing and the POLICY STATEMENT To describe the procedure for credentialing and privileging of Advanced Practice Nurses (APRNs), nurses in expanded roles, and non-hospital employed

More information

All Physicians must attend orientation. Your office will be contacted to schedule a time convenient for you.

All Physicians must attend orientation. Your office will be contacted to schedule a time convenient for you. Dear Doctor: Thank you for your interest in applying for Medical Staff Membership and or Clinical Privileges at Northwest Texas Healthcare System/Northwest Texas Surgery Center and or Alliance Regional

More information

Medical Staff Services. Dear Applicant,

Medical Staff Services. Dear Applicant, Dear Applicant, Thank you for your interest in seeking appointment to the Medical or Allied Health Professional (AHP) Staff of MedStar Montgomery Medical Center. All initial appointments to the Medical

More information

Application for Medical Staff Appointment and Clinical Privileges. Part I. Credential Review

Application for Medical Staff Appointment and Clinical Privileges. Part I. Credential Review Application for Medical Staff Appointment and Clinical Privileges Part I. Credential Review I am applying for clinical privileges at the location(s) checked below: 6209 16 th Avenue, Brooklyn, NY 11214

More information

POLICY and PROCEDURE. TITLE: Allied Health Professionals. TITLE: Allied Health Professionals

POLICY and PROCEDURE. TITLE: Allied Health Professionals. TITLE: Allied Health Professionals POLICY and PROCEDURE TITLE: Allied Health Professionals Number: 13373 Version: 13373.3 Type: Administrative - Medical Staff Author: Martha Hoover Effective Date: 1/15/2015 Original Date: 8/31/1997 Approval

More information

The University of Utah Health Plans offers the following plans and networks. Please specify the networks you are interested in participating with:

The University of Utah Health Plans offers the following plans and networks. Please specify the networks you are interested in participating with: Provider Networks Provider Applicant Process University of Utah Health Plans (UUHP) contracts with physicians and other health care professionals and facilities to offer provider networks essential to

More information

Please Note: Please send all documentation related to the credentialing portion of this documentation to:

Please Note: Please send all documentation related to the credentialing portion of this documentation to: Please ote: The application process is split into different actions. Please send all documentation related to the contracting portion of this documentation to: Fax to: (916)350-8860 Or email to: BSCproviderinfo@blueshieldca.com

More information

TENNESSEE DEPARTMENT OF HEALTH

TENNESSEE DEPARTMENT OF HEALTH TENNESSEE DEPARTMENT OF HEALTH MANDATORY PRACTITIONER PROFILE QUESTIONNAIRE FOR LICENSED HEALTH CARE PROVIDERS The Health Care Consumer Right-to-Know Act of 1998, T.C.A. 63-51-101, et seq., requires designated

More information

Supplement to Clinical Training and ERAS Application

Supplement to Clinical Training and ERAS Application Supplement to Clinical Training and ERAS Application The Johns Hopkins Hospital 600 North Wolfe Street Baltimore MD 21287 Johns Hopkins Bayview Medical Center 4940 Eastern Avenue Baltimore MD 21224 The

More information

Community Health Group Allied Health Professional Application

Community Health Group Allied Health Professional Application Community Health Group Allied Health Professional Application Nurse Practitioner Certified Nurse Midwife LCSW Clinical Psychologist MFCC Other I. INSTRUCTIONS This form should be typed or legibly printed

More information

TITLE: Locum Tenens (LT) Policy

TITLE: Locum Tenens (LT) Policy TITLE: Locum Tenens (LT) Policy Effective Date: 2/2014 Locum Tenens (LT) practitioners are defined as those who temporarily fulfill the duties of another. Requests for LT must come from a group whose practitioners

More information

Credentialing and Privileging. Mary Coffey, MBA, RN Executive Director, Kenosha Community Health Center

Credentialing and Privileging. Mary Coffey, MBA, RN Executive Director, Kenosha Community Health Center Credentialing and Privileging Mary Coffey, MBA, RN Executive Director, Kenosha Community Health Center 1 The goal of this Continuing Education Program is to provide health care professionals with information

More information

BYLAWS OF THE MEDICAL STAFF OF FAIRBANKS MEMORIAL HOSPITAL

BYLAWS OF THE MEDICAL STAFF OF FAIRBANKS MEMORIAL HOSPITAL BYLAWS OF THE MEDICAL STAFF OF FAIRBANKS MEMORIAL HOSPITAL ADOPTED BY THE MEDICAL STAFF... APRIL 16, 2008 ADOPTED BY THE BANNER HEALTH BOARD... MAY 8, 2008 AMENDED: NOVEMBER 11, 2010 JANUARY 13, 2011 JULY

More information

PRACTITIONER CREDENTIALING APPLICATION Advanced Practice Nurse Prescriber, Certified Nurse Midwife, Physician Assistant

PRACTITIONER CREDENTIALING APPLICATION Advanced Practice Nurse Prescriber, Certified Nurse Midwife, Physician Assistant PRACTITIONER CREDENTIALING APPLICATION Advanced Practice Nurse Prescriber, Certified Nurse Midwife, Physician Assistant Prior to submitting this application it is required that you contact the Provider

More information

MEDICAL STAFF & ALLIED HEALTH PROFESSIONAL STAFF BYLAWS

MEDICAL STAFF & ALLIED HEALTH PROFESSIONAL STAFF BYLAWS MEDICAL STAFF & ALLIED HEALTH PROFESSIONAL STAFF BYLAWS * * * MARYMOUNT HOSPITAL GARFIELD HEIGHTS, OHIO 44125 Board of Trustees Approved 08.18.15 1 TABLE OF CONTENTS PREAMBLE... 6 DEFINITIONS... 7 ARTICLE

More information

DUE DATE: Please note: There will be a $175 late fee assessed for any packets that are received incomplete or not returned prior to this date.

DUE DATE: Please note: There will be a $175 late fee assessed for any packets that are received incomplete or not returned prior to this date. Dear Medical/Adjunct Staff Member: It is time for your biannual reappointment to the Medical Staff/Adjunct Staff of The University Hospital. Attached, you will find your application and delineation of

More information

THE MEDICAL STAFF ORGANIZATIONAL DOCUMENTS

THE MEDICAL STAFF ORGANIZATIONAL DOCUMENTS Medical Staff Administration / 251 E. Huron, Galter 3-104, Chicago, IL 60611 / Office: 312/926-2267 / Fax: 312/926-2019 THE MEDICAL STAFF ORGANIZATIONAL DOCUMENTS Bylaws Credentials Plan Hearing Plan Committee

More information

6325 Hospital Parkway Johns Creek, Georgia 30097 Phone 678-474-7000 emoryjohnscreek.com Dear Provider,

6325 Hospital Parkway Johns Creek, Georgia 30097 Phone 678-474-7000 emoryjohnscreek.com Dear Provider, Dear Provider, Thank you for your recent inquiry in credentialing at Emory Johns Creek Hospital. Through our affiliation with Emory Healthcare, we are pleased to announce that our application process is

More information

Federal Supply Schedule (FSS) 621 I Professional & Allied Healthcare Staffing Services

Federal Supply Schedule (FSS) 621 I Professional & Allied Healthcare Staffing Services Department of Veterans Affairs Federal Supply Service Federal Supply Schedule (FSS) 621 I Professional & Allied Healthcare Staffing Services Product Service Code Q Contract #: V797P-4685a Minimum Qualification

More information

Sixty-fourth Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 6, 2015

Sixty-fourth Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 6, 2015 Sixty-fourth Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 6, 2015 HOUSE BILL NO. 1274 (Representatives Fehr, D. Anderson, Hofstad, Lefor) AN ACT to amend and reenact

More information

RULES AND REGULATIONS FOR LICENSING APPLIED BEHAVIOR ANALYSTS AND APPLIED BEHAVIOR ASSISTANT ANALYSTS

RULES AND REGULATIONS FOR LICENSING APPLIED BEHAVIOR ANALYSTS AND APPLIED BEHAVIOR ASSISTANT ANALYSTS RULES AND REGULATIONS FOR LICENSING APPLIED BEHAVIOR ANALYSTS AND APPLIED BEHAVIOR ASSISTANT ANALYSTS [R5-86-ABA] STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DEPARTMENT OF HEALTH October 2015 INTRODUCTION

More information

West Virginia University Hospitals, Inc. Medical/Dental Staff Bylaws

West Virginia University Hospitals, Inc. Medical/Dental Staff Bylaws West Virginia University Hospitals, Inc. Medical/Dental Staff Bylaws ARTICLE I DEFINITIONS 1.1 Board of Directors Board means the Board of Directors which, as established by State Law, is the governing

More information

Practitioner Profile General Information License Number:

Practitioner Profile General Information License Number: Practitioner Profile General Information Primary Practice Address: (456.039 (1) (a) 3., F.S.) Medicaid: (456.039 (1) (b) (5) d., F.S.) Select Medicaid Statement: This practitioner does participate in the

More information

OHIO STATE DENTAL BOARD

OHIO STATE DENTAL BOARD OHIO STATE DENTAL BOARD APPLICATION FOR AN OFFICE CONSCIOUS SEDATION PERMIT OHIO STATE DENTAL BOARD APPLICATION FOR A PERMIT TO BE RESPONSIBLE FOR AND UTILIZE CONSCIOUS SEDATION Please Print or Type Registration

More information

THE LONG ISLAND HOME MEDICAL STAFF BYLAWS

THE LONG ISLAND HOME MEDICAL STAFF BYLAWS THE LONG ISLAND HOME MEDICAL STAFF BYLAWS South Oaks Hospital A Comprehensive Behavioral Health Center Broadlawn Manor Nursing and Rehabilitation Center A Comprehensive Long-Term And Sub-Acute Care Facility

More information

CRNA APPLICATION/CHECKLIST INSTRUCTIONS:

CRNA APPLICATION/CHECKLIST INSTRUCTIONS: MAXIM is an equal opportunity Employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin,

More information