Classification and Clinical Privileges Request

To request a change in classification or to request clinical privileges at any or all of the Atrium Health facilities please complete and submit this form. Please note that you must have current membership at one of the Atrium Health facilities listed.

Classification and Clinical Privileges Request

Please Select Desired Clinical Privilege Location and/or Classification Change. Changes to the Affiliate and or Telemedicine Classification may require an update to your delineation of privileges form.

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