Reappointment Phase I - Clinical Privileges

Please follow the steps below to complete Phase I - Clinical Privileges Update of the reappointment process.

If you wish to keep a privilege that is attached to maintenance criteria, you must provide proof of that maintenance criteria in order to maintain the privilege.

If you are requesting a privilege you currently do not have, you must meet the initial criteria for that privilege.

• Print and complete the Delineation of Privileges (DOP) that reflects your specialty/current practice.
• Return all pages of the form(s) in PDF format to the coordinator assigned to you.
• Jan Horai - Jan.Horai@AtriumHealth.org
• Vicki Hopwood - Vicki.Hopwood@AtriumHealth.org
• Demetrice Ford - Demetrice.Ford@AtriumHealth.org

If you have additional questions you may email Katrina Barkley, Reappointment Supervisor.

Please note: the Atrium forms are being moved to DocuSign - please contact your coordinator for more information.

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Ambulatory Surgery Center, Endoscopy Center and Scotland Forms

Scotland Health Care System - APP and Physician Forms

Atrium Health Surgery Center Shelby - APP and Physician Forms

Center for Orthopaedic Surgery (COS) - APP and Physician Forms

Atrium Health Surgery Center Indian Trail - APP and Physician Forms

Carolinas Gastro Centers - Kenilworth and Ballantyne location - APP And Physician Forms

Thank you for your commitment to Atrium Health!