Floyd Medical Center Forms

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:
- Latasha Bolton - Latasha.Bolton@AtriumHealth.org
- Shawanta Whitehead - Shawanta.Whitehead@AtriumHealth.org
- Sheri Carter - Sheri.Carter@AtriumHealth.org

If you have additional questions, email Shauna Guy Noel, Supervisor, Medical Staff Services.

Click on the link below to print and complete the Delineation of Privileges form.