SUTTER MEDICAL CENTER, SACRAMENTO Department of Psychiatry Privilege List - Delineation of Privileges
|
|
- Caren Johnson
- 7 years ago
- Views:
Transcription
1 INITIAL: [ ] RENEWED: [ ] DATE: ADDITIONAL: [ ] Privileges are granted for Sutter General Hospital, Sutter Memorial Hospital, Capital Pavilion Surgery Center, and Sutter Center for Psychiatry or Sutter Oaks Midtown and exercise of privileges is based on the type of care, treatment and services provided at each facility. To request Privileges, please place an X in the request column. In Number Performed box, indicate the number of identified procedures performed in from any facility. If the condition/privilege you desire is not included on this form, please submit a separate written request along with appropriate documentation of training and/or experience. Request Programs Appointment [ ] Admission and Treatment of Adults (18 years and over) at Sutter Center for Psychiatry (SCP) Competence demonstrated by documentation of Board certification by the American Board of Psychiatry and Neurology or successful completion of a minimum of 3 years residency training in Psychiatry. First six admissions as attending [ ] Admission and Treatment of Adolescents (Age 13 through the age of 17 years) at SCP Psychiatrists or psychologists who are members of the Medical Staff may request privileges to admit and treat s (those 13 through 17 years of age) to the or child units after demonstration of relevant training and/or experience in mental health. (Relevant Training - Applicant must submit a onepage summary of their training and/or experience in psychiatry. The Psychiatry Administrative Committee will determine whether training is relevant to approve the applicant s request for privileges.) Those Medical Staff members with adult privileges who apply for privileges will be proctored by a Medical Staff member with privileges on six admissions.
2 Request Programs Appointment [ ] Admission and Treatment of Children (through the age of 12 years) at SCP Training and Experience : Members of the Department of Psychiatry who wish privilege in Child Psychiatry will be either board eligible or board certified by the American Board of Psychiatry and Neurology in Child Psychiatry or psychologists who are members of the Medical Staff who demonstrate special training and experience in working with children. Six cases proctored by Member of the Child Psychiatry Staff holding full staff privileges (Three child and three ) unless applicant is also applying for Adult Psychiatry Privileges in which case the requirement drops to three cases. Request Privileges Appointment [ ] Formal Psychological Testing Must demonstrate practice experience and Formal Psychological Testing Certification Pre-requisite: 6 cases by a staff psychologist [ ] Informal Sub-Section of Interventional Psychiatry Members of the Department of Interventional Psychiatry who wish privileges in the Sub-Section of IP will hold ECT Privileges. Page 2 of 5
3 Request Privileges Appointment [ ] Electroconvulsive Therapy Training and Experience : Criteria for requesting privileges in Electroconvulsive Therapy (ECT) are the same as those for General Psychiatry. These privileges are outlined in the American Psychiatric Association 1990 Task Force Report (pp ) and form the basis of our credentialing procedure for ECT. In addition, the applicant should have completed a formal training module in an ACGME Psychiatric Residency or hold current ECT privileges at another. If the applicant is more than five years post-residency, he/she should complete a one-week post-graduate training module which includes both didactic and hands-on training. [ ] Vagus Nerve Stimulation (VNS) Training and Experience : 1. Prerequisite - Currently hold Electroconvulsive Therapy (ECT) procedure privileges at a Joint Commission 2. Evidence of completion of manufacturer training/certification to perform treatments with VNS.. Six (6) proctored cases of ECT during hospital stay (minimum of three treatments) in which three procedures on each case are observed by proctor. privileges. settings per patient) Six (6) ECT procedures on at least two patients within the last two years are required. Completion of twelve treatment. Page 3 of 5
4 Request Privileges Appointment [ ] Transcranial Magnetic Stimulation (TMS) Training and Experience : 1. Prerequisite - Currently hold Electroconvulsive Therapy (ECT) procedure privileges at a Joint Commission 2. Evidence of completion of manufacturer training/certification to perform treatments with the TMS device. privileges. treatments per case). Completion of 12 (12) treatment [ ] Ketamine Drip Treatment Prerequisite - Currently hold Electroconvulsive Therapy (ECT) procedure privileges at a Joint Commission Must Hold Privileges for Sedation and Analgesia Performed by Non-Anesthesiologists Physician must be familiar with literature regarding Ketamine Infusion Therapy as determined by interview with the Director of the ECT Program privilege. infusions per case). Completion of five (5) treatment. Page 4 of 5
5 Documentation of Volume Criteria for Special privileges # of procedures performed last 2 years # of procedures performed last 5 years Hospitals where performed Ketamine Infusion Therapy Transcranial Magnetic Stimulation (TMS) Vagus Nerve Stimulation (VNS) Please be prepared to supply verification of volume performance if requested. PHYSICIAN S SIGNATURE Acknowledgment of Practitioner: I understand that (a) in exercising clinical privileges granted, I am constrained by Medical Staff Policies and Procedures, Rules and Regulations, and (b) any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actions are governed by the applicable section of the Medical Staff Bylaws. I hereby attest to having performed the stipulated number of procedures as indicated above, thereby meeting the criteria for those privileges I have requested. ************************************************************************************************************************ COMMITTEE APPROVALS Surgery QI/Administrative Committee Date: Or Dept Chief (in lieu of mtg) Credentials Committee Date: Medical Executive Committee Date: Board of Directors Date: TEMPORARY PRIVILEGE APPROVAL Department Chief: Date: Document Approvals: Department of Psychiatry: 11/22/11 Credentials Committee: 12/13/11 Medical Executive Committee: 12/20/11 Board of Directors: 01/9/12. Page 5 of 5
104 CMR: DEPARTMENT OF MENTAL HEALTH 104 CMR 33.00: DESIGNATION AND APPOINTMENT OF QUALIFIED MENTAL HEALTH PROFESSIONALS
104 CMR 33.00: DESIGNATION AND APPOINTMENT OF QUALIFIED MENTAL HEALTH PROFESSIONALS Section 33.01: Legal Authority to Issue 33.02: Authorization to Apply for Hospitalization Pursuant to M.G.L. c. 123,
More informationPSYCHOLOGIST CLINICAL PRIVILEGES
Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 05/07/2014 Applicant: Check off the Requested box for
More informationPSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER CLINICAL PRIVILEGES
Name: Page 1 Initial Appointment Reappointment Department Specialty Area All new applicants must meet the following requirements as approved by the governing body effective: 6/3/15 Applicant: Check off
More informationSUTTER MEDICAL CENTER, SACRAMENTO Department of Cardiovascular Disease Cardiology - Delineation of Privileges
INITIAL: [ ] RENEWED: [ ] DATE: ADDITIONAL: [ ] Privileges are granted for Sutter General Hospital, Sutter Memorial Hospital, Sutter Center for Psychiatry, Sutter Oaks Midtown and the Capitol Pavilion
More informationDETROIT MEDICAL CENTER CLINICAL PRIVILEGES IN PSYCHOLOGY
CLINICAL PRIVILEGES IN PSYCHOLOGY Page 1 of 4 PSYCHOLOGY: 1) Doctorate (Ph.D., Psy.D. or Ed.D.) in clinical psychology or a closely allied area of psychology. 2) Successful completion of an internship
More informationPhoenix, Arizona. Department of Psychiatry. Rules and Regulations
Phoenix, Arizona Department of Psychiatry Rules and Regulations ARTICLE I ARTICLE II ARTICLE III Organization Functions and Duties Miscellaneous Provisions ARTICLE IV Organization Section 1 In accordance
More informationMENTAL HEALTH INPATIENT INITIAL CERTIFICATION APPLICATION Chapter DHS 61.71 and 61.79
DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Quality Assurance Chapter DHS 61.71 and 61.79, Wis. Admin. Code Page 1 of 9 MENTAL HEALTH INPATIENT INITIAL CERTIFICATION APPLICATION Chapter
More informationLoma Linda University Children s Hospital. EMERGENCY MEDICINE SERVICE Rules and Regulations
I. RESPONSIBILITIES: Loma Linda University Children s Hospital EMERGENCY MEDICINE SERVICE Rules and Regulations The Emergency Medicine Service of Loma Linda University Children s Hospital is responsible
More informationCLINICAL PRIVILEGES- NURSE ANESTHETIST
Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 8/5/2015. Applicant: Check off the Requested box for
More informationPHYSICAL MEDICINE AND REHABILITATION CLINICAL PRIVILEGES
Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 4/3/2013. Applicant: Check off the Requested box for
More informationPOLICY ON RESIDENT SUPERVISION General Psychiatry Residency Program DEPARTMENT OF PSYCHIATRY August 2010
Department of Psychiatry www.uthscsa.edu/psychiatry POLICY ON RESIDENT SUPERVISION General Psychiatry Residency Program DEPARTMENT OF PSYCHIATRY August 2010 Section I. Introduction Careful supervision
More informationUNM SRMC MODERATE AND DEEP SEDATION CLINICAL PRIVILEGES.
MODERATE DEEP SEDATION CLINICAL [ ] Initial Appointment [ ] Reappointment Instructions For some practitioners, the privilege of PROCEDURAL SEDATION is requested as a non-core privilege The individual requesting
More informationSUBJECT: Physician Credentialing and Re-Appointment. INITIATOR: Manager, Medical Staff Credentialing (Signature on File) 03/2015 Jacqueline Ladewig
Policy Number: SW010 Page 1 of 16 United Therapies, LLC provides management and other services to United Mobile Therapies, LLC (United Mobile) and United Urology Centers, LLC (United Urology). Each of
More informationOur faculty has been hand-picked for their knowledge, experience, and enthusiasm for teaching
We welcome your interest in Advocate Lutheran General Hospital s Psychiatry Residency Program. ALGH is a 638-bed teaching hospital located adjacent to Chicago on the northwest side. We proudly provide
More informationSPORTS MEDICINE CLINICAL PRIVILEGES
Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 4/3/2013. Applicant: Check off the Requested box for
More informationProfessional Criteria and Medicaid Reimbursable Outpatient Services by Professionals
IOWA PLAN F BEHAVIAL HEALTH RE: Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals The purpose of this document is to clarify who can provide which outpatient services
More informationHEALTH AND SOCIAL SERVICES 116-6
HEALTH AND SOCIAL SERVICES 116-6 Chapter PW-MA 25 MEDICAL ASSISTANCE PROGRAM PSYCHOTHERAPY PW-MA 25.01 introduction PW-MA 25.04 Freedom of choice PW-MA 25.92 Definitions PW-MA 26.05 Group sessions PW-MA
More informationUNMH Sleep Medicine Clinical Privileges
o Initial privileges (initial appointment) o Renewal of privileges (reappointment) o Expansion of privileges (modification) All new applicants must meet the following requirements as approved by the UNMH
More informationDelineation Of Privileges Diagnostic Radiology Privileges
DIAGNOSTIC RADIOLOGY - CORE PRIVILEGES Criteria: a) Board certification or qualified for certification by the American Board of Radiology; OR, b) Successful completion of an ACGME or AOA approved Radiology
More informationRENOWN REGIONAL MEDICAL CENTER DEPARTMENT OF ORTHOPAEDICS DELINEATION OF PRIVILEGES
RENOWN REGIONAL MEDICAL CENTER DEPARTMENT OF THOPAEDICS DELINEATION OF PRIVILEGES BASIC EDUCATION: M.D. or D.O. MINIMAL FMAL TRAINING: ABMS Board certification or eligibility, or be able to document equivalent
More informationUCLA Geriatric Psychiatry Fellowship Application Requirements
UCLA Geriatric Psychiatry Fellowship Application Requirements Eligible candidates will have completed an ACGME accredited psychiatry residency program prior to start date of the fellowship. The following
More informationUPMC 1 Delineation of Privileges Request Criteria Summary Sheet CARDIAC CATHETERIZATION
UPMC 1 Facility: UPMC Presbyterian Specialty: MEDICINE KNOWLEDGE Successful Completion of an ACGME/AOA, accredited program TRAINING The successful completion of an approved (ACGME/AOA) post graduate residency
More informationSTATE OF NEBRASKA STATUTES RELATING TO NEBRASKA TELEHEALTH ACT
2014 STATE OF NEBRASKA STATUTES RELATING TO NEBRASKA TELEHEALTH ACT Department of Health and Human Services Division of Public Health Licensure Unit 301 Centennial Mall South, Third Floor PO Box 94986
More informationPARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER DEPARTMENT OF SURGERY Bariatric Surgery
STANDARDS FOR PRIVILEGES In order to be eligible to request clinical privileges for both initial appointment and reappointment, a practitioner must the following minimum threshold criteria. In addition
More informationCLINICAL PRIVILEGES- NEONATAL NURSE PRACTITIONER
Name: Page 1 Initial Appointment Department Reappointment Specialty All new applicants must meet the following requirements as approved by the governing body effective: 04/01/2015 Applicant: Check off
More informationProfessional Criteria and Medicaid Reimbursable Outpatient Services by Professionals
Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals The purpose of this document is to clarify who can provide which outpatient services to Iowa Plan Medicaid members.
More informationSurgical 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 informationDECLARATION FOR MENTAL HEALTH TREATMENT
DECLARATION FOR MENTAL HEALTH TREATMENT I, [DECLARANT], being an adult of sound mind, willfully and voluntarily make this declaration for mental health treatment to be followed if it is determined by 2
More informationClinical Privileges Profile Diagnostic Radiology. Greene Memorial Hospital
Printed Name Clinical Privileges Profile Diagnostic Radiology Greene Memorial Hospital Privileges are covered by an exclusive contract. Practitioners who are not a party to the contract are not eligible
More informationHOUSE 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 information6325 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 informationDETROIT MEDICAL CENTER DEPARTMENT OF MEDICINE DELINEATION OF PRIVILEGES IN GENERAL INTERNAL MEDICINE
DETROIT MEDICAL CENTER DEPARTMENT OF MEDICINE DELINEATION OF PRIVILEGES IN GENERAL INTERNAL MEDICINE APPLICANT NAME: PLEASE PRINT QUALIFICATIONS: Effective July 1, 2009, all new applicants to the DMC will
More informationOptum. Clinical Expertise Checklist
Optum Clinical Expertise Checklist Clinician Name: Phone: Fax: State: License: CAQH # Clinicians in the credentialing or recredentialing process have the following rights: to review information submitted
More informationTHE DEPRESSION RESEARCH CLINIC Department of Psychiatry and Behavioral Sciences Stanford University, School of Medicine
THE DEPRESSION RESEARCH CLINIC Department of Psychiatry and Behavioral Sciences Stanford University, School of Medicine Volume 1, Issue 1 August 2007 The Depression Research Clinic at Stanford University
More informationDETROIT MEDICAL CENTER DEPARTMENT OF PEDIATRICS DELINEATION OF PRIVILEGES IN PEDIATRIC CARDIOLOGY. Applicant Name PLEASE PRINT QUALIFICATIONS:
DETROIT MEDICAL CENTER DEPARTMENT OF PEDIATRICS DELINEATION OF PRIVILEGES IN PEDIATRIC CARDIOLOGY QUALIFICATIONS: Current Board Certification or active participation in the certification process leading
More informationPolicies 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 information1 1 / 2 0 0 8 87 P a g e
86 P age 11/2008 11/2008 87 Page 88 P age 11/2008 11/2008 89 Page 90 P age 11/2008 11/2008 91 Page 92 P age 11/2008 11/2008 93 Page 94 P age 11/2008 11/2008 95 Page 96 P age 11/2008 11/2008 97 Page ATTESTATION
More informationADMINISTRATIVE RULES FOR CLINICAL SOCIAL WORKERS TABLE OF CONTENTS
ADMINISTRATIVE RULES FOR CLINICAL SOCIAL WORKERS TABLE OF CONTENTS PART 1. GENERAL INFORMATION ON LICENSURE OF CLINICAL SOCIAL WORKERS 1.1 THE PURPOSE OF LICENSURE...1 1.2 BUSINESS LOCATION...1 1.3 ADVISORS
More informationNEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-M 1301 MEDICAL ASSISTANCE SERVICES PROVIDED BY EDUCATION AGENCIES
CHAPTER He-M 1300 SPECIALIZED SERVICES PART He-M 1301 MEDICAL ASSISTANCE SERVICES PROVIDED BY EDUCATION AGENCIES Statutory Authority: RSA 186-C:27; I-II He-M 1301.01 Purpose. The purpose of these rules
More informationDENTISTRY CLINICAL PRIVILEGES
Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 4/3/2013. Applicant: Check off the Requested box for
More informationCLINICAL PRIVILEGE WHITE PAPER Psychology
Psychology CLINICAL PRIVILEGE WHITE PAPER Psychology Background Psychology is a broad field that includes the scientific study of mental processes and behavior. It is similar to the medical field of psychiatry.
More informationOptum. Clinical Expertise Checklist
Optum Clinical Expertise Checklist To add or modify your area(s) of expertise and/or attested specialty(ies): Complete and sign this form Fax completed form and any requested supportive documents to Network
More informationCross Examination of Psychological and Psychiatric Experts in Competency Cases
Cross Examination of Psychological and Psychiatric Experts in Competency Cases David W. Thompson, Ph.D., ABPP Clinical Psychology Associates Burlington, Wisconsin This workshop will... Review critical
More informationPhysician Assistant Program
Master of Science (M.Sc.), http://chp.cmich.edu/pa Degree Requirements for PA Students First Year - Summer (15 hours) HSC 630 - Regional Human Anatomy 5(3-4) PHA 624 - Issues in Practice 2(2-0) PHA 633
More information2013 -- S 0197 S T A T E O F R H O D E I S L A N D
======= LC00 ======= 01 -- S 01 S T A T E O F R H O D E I S L A N D IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 01 A N A C T RELATING TO BUSINESSES AND PROFESSIONS - NURSES AND NURSE ANESTHETISTS Introduced
More informationUNMH Procedural Sedation Privileges
o Initial privileges (initial appointment) o Renewal of privileges (reappointment) o Expansion of privileges (modification) All new applicants must meet the following requirements as approved by the UNMH
More informationLAC+USC MEDICAL CENTER & HEALTHCARE NETWORK ATTENDING STAFF ASSOCIATION DELINEATION OF PRIVILEGES FOR THE DEPARTMENT OF DERMATOLOGY
LAC+USC MEDICAL CENTER & HEALTHCARE NETWORK ATTENDING STAFF ASSOCIATION FOR THE DEPARTMENT OF DERMATOLOGY NAME OF APPLICANT DATE Initial Appointment and/or Additional Privileges Reappointment Applicant:
More informationTHE 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 informationGuidelines for Updating Medical Staff Bylaws: Credentialing and Privileging Physician Assistants (Adopted 2012)
Guidelines for Updating Medical Staff Bylaws: Credentialing and Privileging Physician Assistants (Adopted 2012) Executive Summary of Policy Contained in this Paper Summaries will lack rationale and background
More informationCLINICAL SOCIAL WORKER LICENSURE APPLICATION
P.O. Box 110806, Juneau, Alaska 99811-0806 Telephone: (907) 465-2551 E-mail: license@alaska.gov Website: www.commerce.alaska.gov/occ CLINICAL SOCIAL WORKER LICENSURE APPLICATION READ THESE INSTRUCTIONS
More informationMENTAL HEALTH AND SUBSTANCE ABUSE MANAGED CARE NETWORKS HOSPITAL INPATIENT PSYCHIATRIC CARE APPLICATION FOR BCBSM PARTICIPATION GENERAL INFORMATION
MENTAL HEALTH AND SUBSTANCE ABUSE MANAGED CARE NETWORKS HOSPITAL INPATIENT PSYCHIATRIC CARE APPLICATION FOR BCBSM PARTICIPATION GENERAL INFORMATION NOTE: DO NOT USE THIS APPLICATION FOR OWNERSHIP CHANGES.
More information1/18/2013. Topics for Discussion. Learning Objectives. The Affordable Care Act (ACA) and School Psychology. Minnesota School Psychologists Association
The Affordable Care Act (ACA) and School Psychology Minnesota School Psychologists Association Minneapolis, MN January 18, 2013 Topics for Discussion 1. Key Components of ACA Impacting Schools 2. Implications
More informationCredentials 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 informationIntensive Outpatient Psychotherapy - Adult
Intensive Outpatient Psychotherapy - Adult Definition Intensive Outpatient Psychotherapy services provide group based, non-residential, intensive, structured interventions consisting primarily of counseling
More informationCAROLINAS REHABILITATION
CAROLINAS REHABILITATION CURRENT LANGUAGE ORGANIZATIONAL MANUAL OF BYLAWS OF CAROLINAS REHABILITATION (TAB 2) New Language ORGANIZATIONAL MANUAL OF BYLAWS OF CAROLINAS REHABILITATION (TAB 2) ARTICLE II
More informationSJC RULE 1:07 (1) REPORT
SJC RULE 1:07 (1) REPORT COURT: Department FISCAL YEAR: 2015 Type of 1. Counsel in Mental Health Cases A Substituted Judgment and Rogers cases G.L. c. 190B, 5-306A(a) Counsel for incapacitated person or
More informationATTACHMENT I TO APPENDIX B OF UNOS BYLAWS
ATTACHMENT I TO APPENDIX B OF UNOS BYLAWS Designated Transplant Program Criteria XIII. Transplant Programs. A. In order to qualify for membership, a transplant program must utilize, for its histocompatibility
More informationLOCUM 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 information6325 Hospital Parkway Johns Creek, Georgia 30097 Phone 678-474-7000 emoryjohnscreek.com
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 informationDepartment of Veterans Affairs VHA DIRECTIVE 2010-010 Veterans Health Administration Washington, DC 20420 March 2, 2010
Department of Veterans Affairs VHA DIRECTIVE 2010-010 Veterans Health Administration Washington, DC 20420 STANDARDS FOR EMERGENCY DEPARTMENT AND URGENT CARE CLINIC STAFFING NEEDS IN VHA FACILITIES 1. PURPOSE:
More informationHEALTH CARE POWER OF ATTORNEY
HEALTH CARE POWER OF ATTORNEY Under the Uniform Health Care Decisions Act 18-A M.R.S.A. 5-801 et seq. I, currently of,, name street address city Maine, whose birth date is, execute this Health Care Power
More informationDURABLE POWER OF ATTORNEY FOR HEALTH CARE
ELDER LAW & DISABILITY RIGHTS SECTION DURABLE POWER OF ATTORNEY FOR HEALTH CARE I,, am of sound mind, and I (Print or type your full name) voluntarily make this designation. APPOINTMENT OF PATIENT ADVOCATE
More informationBe it enacted by the General Assembly of the State of Colorado:
NOTE: This bill has been prepared for the signature of the appropriate legislative officers and the Governor. To determine whether the Governor has signed the bill or taken other action on it, please consult
More informationBasic Standards for Residency Training in Child and Adolescent Psychiatry
Basic Standards for Residency Training in Child and Adolescent Psychiatry American Osteopathic Association and American College of Osteopathic Neurologists and Psychiatrists Adopted 1980 Revised, 1984
More informationMcLaren 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 informationDEFINITIONS: 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 informationFax # s for CAMH programs and services
INFORMATION AND INSTRUCTIONS STEP 1 BEFORE COMPLETING THE REFERRAL FORM CATS Program / General Psychiatry Memory Clinic, Geriatric Mental Health Program Go to www.camh.net for detailed information on each
More informationEDUCATION ACT (CAP. 327)
Legal Notice 484 of 2012 - Malta Government Gazette No. 19,009 28 December 2012 Amended by; Legal Notice 375 of 2014 - Malta Government Gazette No. 19,323 10 October 2014 EDUCATION ACT (CAP. 327) Bye-Laws
More informationProvider Selection Criteria for PreferredOne Participating Mental Health Practitioners
Provider Selection Criteria for PreferredOne Participating Mental Health Practitioners General Criteria 1. Practitioner must serve a specialty and/or geographic need for the good of the PreferredOne product
More informationPage I. PURPOSE II. III.
1 POLICY: ESTABLISHING NEW PRIVILEGES RELATING TO NEW TECHNOLOGY/EQUIPMENT I. PURPOSE To establish a mechanism for approving a procedure, technique or treatment modality ( New Privilege ) to be newly performed
More information# Category Standard Provisional Standard Notes/Comments
Page1 1 Service Definition/ Required Components Therapeutic Rehabilitation Program is rehabilitative service for adults with SMI and children with SED designed to maximize reduction of mental disability
More informationCredentialing 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 informationAPPENDIX 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 informationApplied Behavior Analysis for Autism Spectrum Disorders
Applied Behavior Analysis for Autism Spectrum Disorders I. Policy University Health Alliance (UHA) will reimburse for Applied Behavioral Analysis (ABA), as required in relevant State of Hawaii mandates,
More informationPsychiatric Residential Treatment Facility (PRTF) Prior Authorization Request
Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Request Please submit this application and all supporting documentation to: Magellan Behavioral Health ATTN: Residential Psychiatric
More informationNew York City Children s Center (NYCCC) Queens Campus (Formerly known as Queens Children s Psychiatric Center) Psychology Extern Training Program
New York City Children s Center (NYCCC) Queens Campus (Formerly known as Queens Children s Psychiatric Center) 74-03 Commonwealth Blvd. Bellerose, New York 11426 (718) 264-4500 Psychology Extern Training
More informationPROPOSED REGULATION OF THE STATE BOARD OF NURSING. LCB File No. R114-13
PROPOSED REGULATION OF THE STATE BOARD OF NURSING LCB File No. R114-13 AUTHORITY: 1-4 and 6-19, NRS 632.120 and 632.237; 5, NRS 632.120 and 632.345. A REGULATION relating to nursing; Section 1. Chapter
More informationDEPARTMENT OF FAMILY MEDICINE Delineation of Privileges. Name: Date:
Page 1 of 5 DEPARTMENT OF FAMILY MEDICINE Delineation of Name: Date: Types of Category I in this category include those procedures and cognitive skills involving serious medical problems that are normally
More informationFAMILY NURSE PRACTITIONER EMERGENCY MEDICINE
Name: Page 1 Initial Appointment Reappointment Department Specialty Area All new applicants must meet the following requirements as approved by the governing body effective: 08/05/2015 Applicant: Check
More informationFairview Health Services SPONSORED MASTER S-LEVEL MENTAL HEALTH SERVICE PROVIDER Professional Practitioner Scope of Practice
Fairview Health Services SPONSORED MASTER S-LEVEL MENTAL HEALTH SERVICE PROVIDER Professional Practitioner Scope of Practice PAGE 1 OF 3 Applicant s Name (please print): CROSSWALK FOR REQUESTING FAIRVIEW
More informationSENATE FILE NO. SF0071. Sponsored by: Senator(s) Massie and Barrasso and Representative(s) Harvey, Hastert and Meuli A BILL. for
00 STATE OF WYOMING 0LSO-0 SENATE FILE NO. SF00 Medical Practice Act amendments. Sponsored by: Senator(s) Massie and Barrasso and Representative(s) Harvey, Hastert and Meuli A BILL for AN ACT relating
More informationHarvard Medical School Department of Psychiatry. Training Programs in Child and Adolescent Psychiatry Residency Application
Harvard Medical School Department of Psychiatry Training Programs in Child and Adolescent Psychiatry Residency Application Cambridge Health Alliance Children s Hospital Boston Massachusetts General Hospital/McLean
More informationPlain Language. Guide
Plain Language Guide Mental Health Act 2009 Disclaimer The information contained in this publication is intended to assist in the interpretation of the Mental Health Act 2009 and is not a substitute for
More informationDETROIT MEDICAL CENTER DEPARTMENT OF EMERGENCY MEDICINE DELINEATION OF PRIVILEGES
DETROIT MEDICAL CENTER DEPARTMENT OF EMERGENCY MEDICINE DELINEATION OF PRIVILEGES Applicant Name: INSTRUCTIONS FOR ALL APPLICANTS 1. ALL applicants for appointment requesting ANY clinical privileges must
More informationConnecticut Data as of July 2003
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Connecticut As of July 2003, 378,961 people were covered under Connecticut Medicaid/SCHIP programs. There were 364,692 enrolled in the
More informationRenown Regional Medical Center Department Of Obstetrics and Gynecology. Policies and Procedures Certified Nurse Midwives ( CNM S)
1. Overview: Department Of Obstetrics and Gynecology Policies and Procedures Certified Nurse Midwives ( CNM S) supports the practice of Nurse Midwifery and will participate with Certified Nurse Midwives
More informationGUIDE TO USE OF TITLE
JUNE 2012 GUIDE TO USE OF TITLE Store at Tab #3 of your Registrant Resource Binder Introduction The use of any title or designation is an effective method of quickly imparting considerable information
More information4) In 37.2 817 C The language says any health care records available. What is meant by available? (Commitment Hearings)
Frequently asked questions: 1) Where and when is the certification program for independent examiners? If one doesn t exist, what happens if no psychiatrists/clinical psychologists are available/willing
More informationEFFECTIVE 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 informationCONNECTICUT GENERAL STATUTES CHAPTER 383c PROFESSIONAL COUNSELORS
CONNECTICUT GENERAL STATUTES CHAPTER 383c PROFESSIONAL COUNSELORS Sec. 20-195aa. Definitions: As used in sections 20-195aa to 20-195ee, inclusive: "Professional counseling" means the application, by persons
More informationMaster of Arts In Counseling Master s degree only
Master of Arts In Counseling Master s degree only School Psychology and Counseling School of Education La Sierra University School of Education 4500 Riverwalk Parkway Riverside, CA 92515 Master of Arts
More informationThis policy applies to: Stanford Hospital and Clinics Lucile Packard Children s Hospital. Date Written or Last Revision: Oct 2012
Providers Page 1 of 13 I. PURPOSE To establish mechanisms for gathering relevant data that will serve as the basis for decisions regarding credentialing and privileging of licensed independent practitioners
More informationBYLAWS 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 information16.10.2.1 ISSUING AGENCY. New Mexico Medical Board, hereafter called the board. [16.10.2.1 NMAC - Rp 16 NMAC 10.2.1, 4/18/02; A, 7/1/03]
TITLE 16 CHAPTER 10 PART 2 OCCUPATIONAL AND PROFESSIONAL LICENSING MEDICINE AND SURGERY PRACTITIONERS PHYSICIANS: LICENSURE REQUIREMENTS 16.10.2.1 ISSUING AGENCY. New Mexico Medical Board, hereafter called
More informationAAMFT MEMBERSHIP GUIDELINES POLICIES, STANDARDS, REQUIREMENTS AND APPLICATION PROCESSES. Last Revised: January 2012
AAMFT MEMBERSHIP GUIDELINES POLICIES, STANDARDS, REQUIREMENTS AND APPLICATION PROCESSES Last Revised: January 2012 1 TABLE OF CONTENTS Standards at a Glance 3 Clinical Fellow Definition and Process 4 Member
More informationWRAPAROUND 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 informationUNC Health Care System Psychiatry. Patient Label Here. PSYCHIATRY GENERAL CONSENT FOR TREATMENT MIM #741s (Page 1 of 5)
UNC Health Care System Psychiatry PSYCHIATRY GENERAL CONSENT FOR TREATMENT MIM #741s (Page 1 of 5) I understand that the University of North Carolina Health Care System (UNC Health Care) is an integrated
More informationFort Hamilton Hospital Specialty: Cardiology Department of Medicine Delineation of Privileges
NAME Fort Hamilton Hospital Specialty: Cardiology Department of Medicine Delineation of Privileges GENERAL CARDIOLOGY Required Qualifications for General Cardiology Education/Training/Experience Must have
More informationSubject: Health; health insurance; autism spectrum disorders. Statement of purpose: This bill proposes to require health insurers6
2010 Page 1 1 2 3 4 5 S.262 Introduced by Senators Carris and Campbell Referred to Committee on Finance Date: Janaury 5, 2010 Subject: Health; health insurance; autism spectrum disorders Statement of purpose:
More informationMASSACHUSETTS GENERAL HOSPITAL Department of Nursing
Page 1 of 21 MASSACHUSETTS GENERAL HOSPITAL Department of Nursing TITLE: CREDENTIALING AND AUTHORIZATION OF NURSES IN THE EXPANDED ROLES AND PHYSICIAN ASSISTANTS WHO ARE MGH AND MGPO EMPLOYEES POLICY:
More information