Center for Orthopaedic Surgery Forms

Please follow the steps below to complete Phase I - Clinical Privileges Update of the reappointment process for Center for Orthopaedic Surgery (COS) privileges.

1) PRINT and COMPLETE - the Delineation of Privileges (DOP) that reflects your specialty/current practice

2) NOTE - if you are requesting a privilege you currently do not have, you must meet the initial criteria for that privilege.

3) RETURN the form(s) to the coordinator assigned to you

• Staci Hightower - staci.hightower@atriumhealth.org
• Allison Eury - allison.eury@atriumhealth.org

If you have additional questions you may contact Staci Hightower, Supervisor here.

Physician Forms:

COS Anesthesia

COS General Surgery, Breast Oncology

COS Orthopaedics

Advance Practice Provider (APP) Forms:

COS Anesthesia Assistant

COS Certified Registered Nurse Practitioner (C.R.N.A.)

COS Physician Assistant (P.A.)

Thank you for your commitment to Atrium Health!