Application for Re-Appointment

Clinical Privileges Update

• You will receive your DOP (Delineation of Privileges) via DocuSign
• Complete the online application using the link below

Reappointment Application

• Providers will complete the online application via the link(s) below
• Application must be returned by stated deadline to avoid loss of clinical privileges
• Influenza Exemption Request - Please follow the instructions provided by clicking on the link below. You will receive an Approval or Denial from Atrium Health Teammate Health and will share your notification with the Reappointment coordinator assigned to you.
  • Eform - Vaccination Exemption Instructions

If you plan to resign prior to or by your current term expiration date you do NOT need to complete the reappointment application. However, you must notify Sonya Greene or Katrina Barkley of this information upon receipt of your reappointment packet.

Mandatory Medical Staff Education PowerPoint

• Open and review the Medical Staff Education PowerPoint which relates to Medical Education for EMTALA, Emergency Management, Corporate Privacy, Pain Assessment and Management, Antimicrobial Stewardship, Infection Prevention and Restrictive Interventions. This is a requirement per your Medical Staff Bylaws and The Joint Commission.
• Your signed attestation within the Application Module will acknowledge you have read each education piece.

Application Module

• Log in to the Application Module
• Check all information carefully for completeness and accuracy
• All sections included in the application must be completed or your application will be deemed incomplete
• Click on My Apps > Atrium Health Tab
• Verify/Edit each field on the left-hand side
• Health status - input Flu (documentation required)
• Answer all questions under "Supplements"
• Click "Review Information"
• Go to "Sign Documents"
• "Click to Sign" the Reappointment Application and Additional Documents (total of 2 forms to sign)
  • If you are a new appointee you will only see an Addendum to the Reappointment Application
• Type in your full name at the bottom of the document
• Click the green "Submit" button once all documents are signed
  • The Medical Staff Office will not get notification of your submission unless you have clicked "Submit"