Kyle Seale Parkway Ambulatory Surgery Center

Credentialing & Privileging

10 APPOINTMENT AND PRIVILEGING

• 10.5 Appointment and Privileging

20 CREDENTIALING PROCEDURE

• 20.7 Credentialing Procedure
• 20A.6 Checklist for Appointment and Updates
• 20B.1 Initial Pre-Application Request
• 20C.1 Appointment Application Doc and CRNA
• 20D.1 Application for Allied Health Professional
• 20G.4 Disclosure
• 20H Release of Info and Acknowledgement
• 20J Healthcare Facility Verification Letter
• 20K Peer Reference Letter
• 20L.1 Appointment Review Form
• 20M Appointment Granted Letter
• 20N.1 Release Malpractice Insurance
• 20O Texas Standardized Credentialing Application

30 PRIVILEGE REQUEST

• 30.1 Privilege Request

40 TEMPORARY PRIVILEGES

• 40.3 Temporary Privileges

45 EMERGENCY TEMPORARY PRIVILEGES

• 45.1 Emergency Temporary Privileges

50 COMMUNICATION OF PRIVILEGES

• 50 Communication of Privileges

60 SUPERVISION OF THE SCOPE OF PRACTICE

• 60.1 Supervision of the Scope of Practice
• 60A Proctoring Participation Letter
• 60B Surgical Proctoring Report

70 REAPPOINTMENTS

• 70.6 Reappointment and Clinical Privileges Update
• 70A Reappointment Review Form
• 70B.1 Reappointment Application Cover Letter
• 70C.2 Reappointment Application
• 70E Reappointment Less Than 20 Cases
• 70F.1 Reappointment Application For Allied Health Professionals
• 70G Reappointment Granted Letter
• 70H Reappointment Checklist

75 VOLUNTARY EXPIRATION

• 75A Voluntary Expiration Medical Staff
• 75B Voluntary Expiration Allied Health Professional

80 MAINTENANCE OF CREDENTIALS FILES

• 80.1 Maintenance of Credentials Files

90 ADVERSE ACTIONS, HEARING AND APPELLATE REVIEW

• 90 Adverse Actions, Hearing and Appellate Review

100 REPORTING ADVERSE ACTIONS

• 100.1 Reporting Adverse Actions

110 ACCESS TO CREDENTIALS FILES

• 110 Access to Credentials Files

120 ALLIED HEALTH PROFESSIONAL

• 120.2 Allied Health Professional

130 PHYSICIAN EMPLOYED ASSISTANT

• 130.1 Physician Employed Assistant

132 STUDENT RESIDENT FELLOW

• 132.4 Student Resident Fellow
• 132A.1 Student, Resident, Fellow Status Confirmation

140 FORMAT OF THE PRACTITIONER’S FILE

• 140.3 Format of the Practitioner’s File

500 DELINEATION

• Delineation AHP Other Than CNRA
• Delineation Anesthesiology
• Delineation Anesthetist
• Delineation Cardiology
• Delineation Cardiovascular
• Delineation Gastroenterology
• Delineation General Surgery
• Delineation Gynecology
• Delineation Laser
• Delineation Lithotripsy-RN
• Delineation Lithotripsy-Tech
• Delineation Neuro Spine
• Delineation Oncology
• Delineation Ophthalmology
• Delineation Oral Surgery
• Delineation Orthopedics
• Delineation Otolaryngology-ENT
• Delineation Pain Management
• Delineation Physiatry
• Delineation Plastic Surgery
• Delineation Podiatry
• Delineation Radiology
• Delineation Rehab Medicine
• Delineation Urology